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Ultrasound-guided Placement of Permanent Hemodialysis Catheters Compared to the Traditional Blind Method

Arash Mohammadi Tofigh, Farbod Emami Yeganeh, Elham Mirzaian, Behzad Nemati Honar




Background: Central venous hemodialysis catheters are one of the most common vascular accesses for patients suffering from end-stage kidney disease. The application of ultrasound-guided placement of permanent hemodialysis catheters is highly recommended by the new guidelines because of its advantages over the traditional blind methods.
Methods: In this prospective study, the samples comprised patients (N=80) referred to a vascular surgery clinic by their nephrologist or elective vascular surgery consultations and asking for the placement of permanent hemodialysis catheters in Imam Hossain Hospital (A referral hospital complex center in, Tehran, Iran) during 2014 to 2015. The patients were randomly divided into two groups (n=40); one of the groups underwent the placement of catheters with the guidance of Doppler ultrasound and the other with the traditional blind method. Then, the data were analyzed by SPSS V. 21 software.
Results: There was statistically significant fewer attempts for successful placement (Z= -2.725, P=0.006), less insertion failure (Chi-Square=9.600, P=0.002), fewer failures with the first attempt (Chi-square=9.600, P=0.002), and less total placement time (t=1.379, df=69.549, P=0.172) in the sonography-guided group compared to the blind method. Furthermore, there was no significant difference in venous cannulation time and complications such as pneumothorax, neck hematoma, and carotid puncture between the two groups. Moreover, the patients had significantly greater satisfaction with the sonography-guided method (Z=-4.306, P=0.0001).
Conclusion: According to this study, it might be beneficial to use ultrasound as the first method of permanent hemodialysis catheters insertion and patients would be more satisfied with this approach as well. In addition, learning the blind method is recommended to the practitioners because of the possibility of lacking ultrasound in an emergency.


Dialysis, Catheters, Anatomic landmarks, Ultrasonography, Doppler


‎1.‎ Mactier R, Hoenich N, Breen C. Renal association clinical practice guideline on haemodialysis. Nephron Clinical Practice. 2011; ‎‎118(Suppl. 1):c241-c86. [DOI:10.1159/000328072] [PMID]‎

‎2.‎ Rabindranath KS, Kumar E, Shail R, Vaux E. Use of real-time ultrasound guidance for the placement of hemodialysis catheters: A ‎systematic review and meta-analysis of randomized controlled trials. American Journal of Kidney Diseases. 2011; 58(6):964-70. ‎‎[DOI:10.1002/14651858.CD005279.pub4] [PMID]‎

‎3.‎ Serafimidis K, Sakorafas GH, Konstantoudakis G, Petropoulou K, Giannopoulos GP, Danias N, et al. Ultrasound-guided ‎catheterization of the internal jugular vein in oncologic patients; comparison with the classical anatomic landmark technique: A ‎prospective study. International Journal of Surgery. 2009; 7(6):526-8. [DOI:10.1016/j.ijsu.2009.08.011] [PMID]‎

‎4.‎ Kumar A, Chuan A. Ultrasound guided vascular access: Efficacy and safety. Best Practice & Research Clinical Anaesthesiology. ‎‎2009; 23(3):299-311. [DOI:10.1016/j.bpa.2009.02.006]‎

‎5.‎ Pisoni RL, Gillespie BW, Dickinson DM, Chen K, Kutner MH, Wolfe RA. The Dialysis Outcomes and Practice Patterns Study ‎‎(DOPPS): Design, data elements, and methodology. The American Journal of Kidney Diseases. 2004; 44(5 Suppl. 2):7-15. ‎‎[DOI:10.1053/j.ajkd.2004.08.005] [PMID]‎

‎6.‎ Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: An international ‎perspective from the dialysis outcomes and practice patterns study. Nephrology Dialysis Transplantation. 2008; 23(10):3219-26. ‎‎[DOI:10.1093/ndt/gfn261] [PMID] [PMCID]‎

‎7.‎ Natoinal Institute for Health and Care Excellence. Guidance on the use of ultrasound locating devices for placing central venous ‎catheters. London: National Institute for Clinical Excellence; 2002.‎

‎8.‎ Bailey PL, Glance LG, Eaton MP, Parshall B, McIntosh S. A survey of the use of ultrasound during central venous catheterization. ‎Anesthesia & Analgesia. 2007; 104(3):491-7. [DOI:10.1213/01.ane.0000255289.78333.c2] [PMID]‎

‎9.‎ Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency ‎department increases success rates and reduces complications: A randomized, prospective study. Annals of Emergency Medicine. ‎‎2006; 48(5):540-7. [DOI:10.1016/j.annemergmed.2006.01.011] [PMID]‎

‎10.‎ Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: A critical analysis of patient ‎safety practices. Evidence Report/Technology Assessment (Summary). 2001; (43):i-x 1-668. [PMID] [PMCID]‎

‎11.‎ Prabhu MV, Juneja D, Gopal PB, Sathyanarayanan M, Subhramanyam S, Gandhe S. Ultrasound-guided femoral dialysis access ‎placement: A single-center randomized trial. Clinical Journal of the American Society of Nephrology. 2010; 5(2):235-9. ‎‎[DOI:10.2215/CJN.04920709] [PMID] [PMCID]‎

‎12.‎ Denys B, Uretsky B, Reddy P. Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the ‎external landmark-guided technique. Circulation. 1993; 87(5):1557-62. [DOI:10.1161/01.CIR.87.5.1557] [PMID]‎

‎13.‎ Taal MW, Chesterton LJ, McIntyre CW. Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals ‎significant occult stenosis. Nephrology Dialysis Transplantation. 2004; 19(6):1542-5. [DOI:10.1093/ndt/gfh216] [PMID]‎

‎14.‎ Nadig C, Leidig M, Schmiedeke T, Höffken B. The use of ultrasound for the placement of dialysis catheters. Nephrology Dialysis ‎Transplantation. 1998; 13(4):978-81. [DOI:10.1093/ndt/13.4.978] [PMID]‎

‎15.‎ Ashby D, Borman N, Burton J, Corbett R, Davenport A, Farrington K, et al. Renal association clinical practice guideline on ‎haemodialysis. BMC Nephrology. 2019; 20:379. [DOI:10.1186/s12882-019-1527-3] [PMID] [PMCID]‎

DOI: https://doi.org/10.32598/ijmtfm.v9i4.25389