Routine Chest Radiography Following Tunneled Hemodialysis Catheter: Use and Clinical Outcomes

Highlights Abstract Background: A postoperative chest x-ray (CXR) remains part of some hospital protocols following tunneled hemodialysis catheter placement despite the use of operative imaging-guided techniques. The aim is to assess the usefulness of this practice and its impact on clinical outcomes and resource use. Methods: A review of medical records and postoperative CXR was done for 78 adult patients who had tunneled hemodialysis catheters placed in the operating room under fluoroscopy guidance. Catheters were inserted by ultrasound-guided puncture (51.3%) or exchanged from an existing catheter over a guide wire (48.7%). The postoperative CXRs were also examined by an independent reviewer to assess the catheter tip position and the need for repositioning to mimic a real-life postoperative setting. Procedural, nursing, and billing records were also reviewed. Results: No patients had a pneumothorax or major complications. On postoperative CXRs, 29 (37.2%) patients had the catheter tips in the right atrium, 23 (29.5%) in the cavoatrial junction, 25 (23.1%) in the superior vena cava, and 1 (1.3%) in the brachiocephalic vein. The independent reviewer found the catheter tips in acceptable anatomical positions in 75 of 78 patients. Only 3 (3.9%) patients had catheter malfunctions during dialysis and exchanged their catheters (2 had high catheters in the superior vena cava and brachiocephalic vein, 1 had a kinked catheter). Postoperative CXRs also caused delays in patient discharge from postanesthesia care units and significant increases in medical expenses (around $199 per patient). Conclusion: Routine CXR after tunneled hemodialysis central venous catheter insertion is unnecessary and does not add to the procedure's safety or to the patient's outcome.

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The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520955090 ◽

2020 ◽

pp. 026835552095509

Author(s):

Yuliang Zhao ◽

Letian Yang ◽

Yating Wang ◽

Huawei Zhang ◽

Tianlei Cui ◽

...

Keyword(s):

Internal Jugular Vein ◽

Superior Vena Cava ◽

Subclavian Vein ◽

Jugular Vein ◽

Superior Vena ◽

Vena Cava ◽

Brachiocephalic Vein ◽

Central Venous ◽

Hemodialysis Catheter ◽

Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

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Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

Korean Journal of Radiology ◽

10.3348/kjr.2011.12.5.629 ◽

2011 ◽

Vol 12 (5) ◽

pp. 629 ◽

Cited By ~ 4

Author(s):

Peter Isfort ◽

Tobias Penzkofer ◽

Fabian Goerg ◽

Andreas H. Mahnken

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Brachiocephalic Vein ◽

Central Venous ◽

Left Brachiocephalic Vein

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Left Brachiocephalic Vein Stenosis due to the Insertion of a Temporal Right Subclavian Hemodialysis Catheter

Case Reports in Vascular Medicine ◽

10.1155/2017/9524739 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Eleni I. Skandalou ◽

Fani D. Apostolidou-Kiouti ◽

Ilias D. Minasidis ◽

Ioannis K. Skandalos

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Brachiocephalic Vein ◽

Central Vein ◽

Left Brachiocephalic Vein ◽

Hemodialysis Catheter ◽

The Right ◽

Vein Stenosis ◽

Central Vein Stenosis

Central vein stenosis/occlusion is a common well-described sequel to the placement of hemodialysis catheters in the central venous system. The precise mechanisms by which central vein stenosis occurs are not well known. Current concepts in central vein stenosis pathophysiology focus on the response to vessel injury model, emphasizing the process of trauma. A case of left brachiocephalic vein stenosis due to the insertion and function of a temporary right subclavian hemodialysis catheter is presented. The purpose of the manuscript is to emphasize that, with the introduction of a temporary subclavian hemodialysis catheter via the right subclavian vein apart from causing concurrent stenosis/infarction of the right subclavian and right brachiocephalic vein, it is also possible to cause stenosis of the left brachiocephalic vein (close to its contribution to the superior vena cava) although the catheter tip is placed in the correct anatomical position in the superior vena cava.

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Placement of Tunnelled Hemodialysis Catheters across Stenotic and Occluded Central Veins

The Journal of Vascular Access ◽

10.1177/112972980300400102 ◽

2003 ◽

Vol 4 (1) ◽

pp. 3-8 ◽

Cited By ~ 4

Author(s):

A. Falk ◽

A. Alomari ◽

J.E. Silberzweig

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Catheter Insertion ◽

Brachiocephalic Vein ◽

Metallic Stent ◽

Central Venous ◽

Hemodialysis Catheter

Purpose The purpose of this study was to evaluate the efficacy of placement of tunneled hemodialysis catheters in patients with occluded or stenotic central veins. Materials and Methods Data were prospectively collected for 26 patients (11 male, 15 female, mean age 52 years) referred for placement of tunneled hemodialysis catheters with central venous stenoses or occlusions. The central venous occlusions or stenoses were recanalized using traditional interventional catheter and guidewire techniques. Results Thirty central venous access procedures were performed of which 28 (93%) procedures resulted in successful tunneled catheter insertion. Twenty-one internal jugular venous (13 right, 8 left) and 7 subclavian venous (3 right, 4 left) catheters were placed. Eighteen stenotic and 10 occluded venous segments were crossed including the brachiocephalic vein (n = 22), subclavian vein (n = 2), and the superior vena cava (4). One patient required insertion of a metallic stent to facilitate passage of the hemodialysis catheter across an occluded brachiocephalic vein. No procedure-related complications occurred. No episodes of upper extremity swelling or superior vena cava syndrome occurred following catheter insertion. Conclusion Insertion of tunneled hemodialysis catheter across occluded or stenotic central veins is technically feasible and safe. The use of occluded or stenotic central veins for catheter access preserves patent central veins for future shunt access.

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