title: Interventional radiology placement of twin Tesio catheters for dialysis access: review of 75 patients.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of modern interventional radiology techniques and imaging guidance for placement of jugular vein twin Tesio hemodialysis catheters.
  
  
  METHODS
  Eighty-two sets (75 patients) of twin Tesio catheters were percutaneously placed in the right (n = 70) and left (n = 12) internal jugular veins with use of ultrasound (US) and fluoroscopic guidance. Immediate procedural and late complications were recorded. The efficacy of the Tesio system was also evaluated.
  
  
  RESULTS
  With US and fluoroscopic guidance, the technical success for access and catheter placement was 100%. Measured dialysis blood flow rate of greater than 375 mL/min was obtained in 95% of the patients and recirculation averaged 4.6% +/- 5%. An inadvertent common carotid artery puncture occurred in one (0.6%) patient and prolonged exit site bleeding occurred in another five patients (3%). Each of these was successfully controlled with compression. More chronically, catheter thrombosis and exit site infection occurred each at the rate of 0.16 episodes per 100 catheter days. All thrombosis and exit site infections responded to local thrombolysis and antibiotic therapy, respectively. Bacteremia occurred in 20 patients and required catheter removal in five patients. There was no clinical evidence of upper extremity or superior central vein thrombosis.
  
  
  CONCLUSIONS
  Placement of internal jugular, twin Tesio catheters with use of imaging and interventional techniques provides a safe and efficacious means of either short or long-term hemodialysis.
authors.affiliation: Department of Radiology, University of Florida College of Medicine, Gainesville 32610-0374, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Caridi
authors.forename: L S
authors.initials: LS
authors.lastname: Grundy
authors.forename: E A
authors.initials: EA
authors.lastname: Ross
authors.forename: P N
authors.initials: PN
authors.lastname: Prabhu
authors.forename: J C
authors.initials: JC
authors.lastname: Tonkin
authors.forename: I F
authors.initials: IF
authors.lastname: Hawkins
authors.forename: B N
authors.initials: BN
authors.lastname: Wiechmann
authors.forename: D J
authors.initials: DJ
authors.lastname: Pevarski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy; D001783:Blood Flow Velocity; D020212:Carotid Artery Injuries / Q000209:etiology; D017536:Carotid Artery, Common / Q000473:pathology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000145:classification; D005260:Female; D005471:Fluoroscopy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012449:Safety; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents