Translumbar inferior vena cava cannulation.
BACKGROUND
The aim of the study was to review our three year experience with translumbar insertion of dialysis catheters.


METHODS
In five adult patients (4 males and one female, mean age 45 yr), requiring dialysis due to end-stage chronic renal failure, the inferior vena cava was cannulated because of the impossibility of using any other approach. All procedures were performed under fluoroscopy. After visualisation of the inferior vena cava by injection of contrast medium into a peripheral vein, the vena cava was punctured with a 20 cm long needle, at the L3 level. The position of the needle was confirmed by injection of contrast medium, and the vein was then cannulated with a peel-away cannula, using a standard Seldinger technique. Subsequently, a pre-tunneled silastic catheter was introduced and secured.


RESULTS
The catheters were used for from 3 to 10 months. No case of permanent catheter dysfunction was noted. Three episodes of temporary thrombosis, in two patients, were successfully treated with heparin and urokinase. Three catheters became contaminated, but they were treated without the necessity for catheter removal.


CONCLUSIONS
The described method is a safe and effective way of securing haemodialysis access in patients where a standard approach is not possible.
Department of Internal Diseases, Military Medical Institute in Warsaw, 03-984 Warszawa, Poland. gkade5@wp.pl
Grzegorz
G
Kade
Jarosław
J
Leś
Joanna
J
Grzesiak
Antoni
A
Sokalski
Jolanta
J
Buczyńska-Chyl
Zbigniew
Z
Rybicki
Zofia
Z
Wańkowicz
D000328:Adult; D016470:Bacteremia / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000209:etiology; D014508:Urea / Q000378:metabolism; D014682:Vena Cava, Inferior
D014508:Urea