Novel technique for placement of hemodialysis catheters using a combined open procedure with the Seldinger micropuncture technique.
Percutaneous placement of large-diameter dialysis catheters via the Seldinger technique can be technically challenging in patients with coagulopathy, difficult anatomy, or several previous central line insertions. We describe a method for achieving safer access by combining an open approach to delineate the venous anatomy of the chest wall, with a micropuncture device and smaller diameter guidewire to gain intravascular access to the cephalic vein or its major tributaries. Serial dilation of otherwise unusable vessels can then permit successful and safer hemodialysis catheter insertion in these difficult cases.
Maa
J
J
Department of General Surgery, University of California at San Francisco, San Mateo Medical Center, San Francisco, California 94103, USA.
Gosnell
J E
JE
Chuter
T A M
TA
D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods; D003131:Combined Modality Therapy; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D011677:Punctures; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity