Farrell J, Gellens M
The value of ultrasonography in the placement of hemodialysis
access
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1406 1996
The complications of percutaneous placement of large bore
hemodialysis catheters are well known. Portable ultrasound devices
suitable for bedside use in guiding placement have become available.
This retrospective study covering a 1 year period looks at the
authors' experience with ultrasound guidance in the internal jugular
and femoral positions. The technique was more helpful in the IJ
position, with an 83% first pass success with U/S compared to 36%
using landmarks alone (p<0.0001). Ultimate success was achieved in
29/30 pts with U/S, versus 32/39 without. The authors conclude that
U/S guidance leads to fewer attempts and less complications.
Comment: This is a retrospective study, and it is not stated how
patients were chosen to have a first attempt via U/S versus without
U/S. Another variable is operator experience, for either method.
Although it seems clear that bedside U/S guidance will have an
emerging role in acute access placement, a prospective study with
better control over operator and other variables would be more useful
to support the case for U/S guidance.
(James A. Sondheimer MD, Wayne State University, Detroit, MI)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: venous