Transthoracic cuffed hemodialysis catheters: a method for difficult hemodialysis access.
BACKGROUND
Recurrent vascular access failure is a major cause of morbidity in patients receiving long-term hemodialysis. Central venous catheters are often necessary for dialysis, and easily accessed vessels (ie, the internal jugular vein and subclavian vein) frequently occlude because of repeated cannulation. When standard access sites occlude, unconventional access methods become necessary. We report a technique of placing hemodialysis catheters directly into the superior vena cava (SVC).


METHODS
Between January 2002 and December 2004, 22 patients with documented bilateral jugular and subclavian vein occlusion underwent transthoracic SVC permanent catheter placement. Femoral vein access was obtained, and a sheath was placed. Under fluoroscopic guidance, a diagnostic catheter was then inserted into the SVC, and a venogram was obtained. By using the fluoroscopic image as a reference guide, supraclavicular access directly into the SVC was performed with lateral and anteroposterior views to better localize the SVC. Once venous blood was obtained, a hydrophilic wire was passed into the inferior vena cava. A 5F sheath was then placed, and, with the use of an exchange catheter, the wire was switched for a stiffer wire. The hemodialysis catheter was then placed in the standard fashion over this wire.


RESULTS
In a 24-month period, 22 patients underwent transthoracic permanent catheter placement. All patients had the permanent catheters successfully inserted. Two major complications occurred. One patient experienced a pneumothorax, and another patient experienced a hemothorax. Both patients were successfully treated with chest tube decompression. All permanent catheters functioned immediately with a range of 1 to 7 months.


CONCLUSIONS
Transthoracic permanent catheter placement is an appropriate alternative for patients in whom traditional venous access sites are no longer available.
Wellons
Eric D
ED
Atlanta Medical Center, GA 30312, USA. ewellons@hotmail.com
Matsuura
John
J
Lai
Kin-Man
KM
Levitt
Adam
A
Rosenthal
David
D
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D005471:Fluoroscopy; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D011030:Pneumothorax / Q000209:etiology; D006435:Renal Dialysis / Q000379:methods*; D014683:Vena Cava, Superior