title: Outcome of radiologically placed tunneled haemodialysis catheters.
abstract: OBJECTIVE
  To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011.
  
  
  METHODS
  All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed.
  
  
  RESULTS
  Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed.
  
  
  CONCLUSIONS
  Radiological guided tunneled haemodialysis catheter placements are a safe and reasonable means of providing temporary vascular access for haemodialysis patients.
authors.affiliation: Department of Radiology, The Aga Khan University Hospital, Karachi.
authors.forename: Raza
authors.initials: R
authors.lastname: Sayani
authors.forename: Muhammad
authors.initials: M
authors.lastname: Anwar
authors.lastname: Tanveer-ul-Haq
authors.forename: Nauman
authors.initials: N
authors.lastname: Al-Qamari
authors.forename: Muhammad Asif
authors.initials: MA
authors.lastname: Bilal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D051437:Renal Insufficiency / Q000628:therapy*; D013927:Thrombosis / Q000209:etiology; D018084:Ultrasonography, Interventional