Ultrasound-guided femoral dialysis access placement: a single-center randomized trial.
OBJECTIVE
Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmark-guided technique (ALT) for the femoral vein (FV).


METHODS
This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.


RESULTS
Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P = 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P = 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P = 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).


CONCLUSIONS
USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.
Prabhu
Mayoor V
MV
Department of Nephrology, Global Hospitals, Andhra Pradesh, India. drprabhunephro@gmail.com
Juneja
Deven
D
Gopal
Palepu B
PB
Sathyanarayanan
Mohan
M
Subhramanyam
Sreepada
S
Gandhe
Sridhar
S
Nayak
K Shivanand
KS
D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional