title: Image-guided insertion of the Uldall tunneled hemodialysis catheter: technical success and clinical follow-up.
abstract: OBJECTIVE
  To evaluate the technical success, complication rates, and survival time of the Uldall double-lumen catheter placed by interventional radiologists in patients presenting to a hemodialysis clinic.
  
  
  METHODS
  Patients eligible for this study included those with end-stage renal disease (ESRD) who had failed peripheral vascular access or who were awaiting access at a hemodialysis unit between June 1993 and March 1996. All catheters were placed under fluoroscopic and ultrasound guidance in the angiography suite.
  
  
  RESULTS
  Attempts were made to insert 130 catheters into jugular veins in a consecutive series of 61 patients with ESRD. The accumulated catheter experience in this cohort was 15,380 days and the median survival time was 141 days (95% confidence interval [CI]; 116 days-166 days). One hundred twenty-one catheters (93%) were successfully inserted, mainly (94%) into the internal jugular vein. Excellent dialysis blood flow rate was obtained-on average 365 mL/min (95% CI; 350-379 mL/min). The overall infection rate, including exit site (n = 13), sepsis (n = 19), and clavicular osteomyelitis (n = 1), was 2.1 episodes per 1,000 catheter days.
  
  
  CONCLUSIONS
  This catheter is recommended for acute and longer term hemodialysis for patients without peripheral vascular access. It can be inserted percutaneously, the same internal jugular vein can be used repeatedly with few complications and good blood flow, and the technique can be easily learned by any experienced angiographer.
authors.affiliation: Department of Medical Imaging, Toronto Hospital (Western Division), University of Toronto, Ontario, Canada.
authors.forename: K J
authors.initials: KJ
authors.lastname: Schnabel
authors.forename: M E
authors.initials: ME
authors.lastname: Simons
authors.forename: G F
authors.initials: GF
authors.lastname: Zevallos
authors.forename: G E
authors.initials: GE
authors.lastname: Pron
authors.forename: S S
authors.initials: SS
authors.lastname: Fenton
authors.forename: K W
authors.initials: KW
authors.lastname: Sniderman
authors.forename: L C
authors.initials: LC
authors.lastname: Vanderburgh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001783:Blood Flow Velocity; D002408:Catheters, Indwelling / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional / Q000379:methods*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods