title: Practical preprocedure measurement to estimate the required insertion depth and select the optimal size of tunneled dialysis catheter in uremic patients.
abstract: We evaluated two methods for preprocedure predicting the insertion depth of tunneled dialysis catheter (TDC) on chest radiograph (CXR). Patients undergoing TDC insertion via right internal jugular vein were enrolled. By Method 1, the insertion depth was calculated on preprocedure CXR as the distance from the anticipated venous tip (3.5 cm below the cavoatrial junction) to the prearranged skin puncture site (1.5 cm above the right clavicle). By Method 2, the insertion depth was derived by adding the length between the skin puncture site and the upper edge of the clavicle and the length of clavicle-to-tip. The TDC was placed at the estimated insertion depth. The distance of cavoatrial junction-to-arterial tip was then measured from postoperative supine CXR. One hundred and seventy and 121 TDCs were inserted by Method 1 and Method 2, respectively, while 127 and 92 preoperative supine CXR were used for preprocedure measurement. The mean distance of cavoatrial junction-to-arterial tip was 12.055 (8.5684) [mean (SD)], 11.27 (3.3261), 9.524 (5.1590), and 10.538 (2.6956) mm. Methods of determining the insertion depth by preprocedure measurement enable successful TDC tip placement. Method 2 and using preoperative supine CXR enabled more precise and flexible insertion.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Pin-Tarng
authors.initials: PT
authors.lastname: Chen
authors.forename: Chien-Kun
authors.initials: CK
authors.lastname: Ting
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Wang
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Cheng
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D057785:Catheters; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008297:Male; D010865:Pilot Projects; D011677:Punctures; D013902:Radiography, Thoracic; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014511:Uremia / Q000000981:diagnostic imaging / Q000628:therapy*