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Kidney Week

Abstract: SA-PO1090

Ultrasound-Guided Protocol Safely Eliminates Chest Radiography After Non-Tunneled Catheter Placement in Urgent Hemodialysis

Session Information

  • Vascular Access - II
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Ibarra-Sifuentes, Héctor Raúl, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
  • Avila Velazquez, Jose Luis, University Hospital, Monterrey, Mexico
  • Vera, Raymundo, Hospital Universitario, Monterrey, NUEVO LEON, Mexico
  • Arteaga Muller, Giovanna Y., Hospital Universitario, Monterrey, NUEVO LEON, Mexico
Background

Despite its morbidity and mortality, the Non-tunneled catheter (NTC) continues to be an indispensable vascular access when imminent need for Hemodialysis. The confirmation of the proper NTC placement and complications detection are a real concern to optimize patient safety.

Methods

Prospective, comparative study. Included patients aged >17 years with life-threatening complications (uremic syndrome, potasssium >6.5 mmol/L, acidosis pH <7.2 with high anion gap and HCO3 <15 mmol/L and pulmonary edema) all resistant to management and urgent Hemodialysis need. After NTC placement with ultrasound (US) guided Seldinger technique in the right internal jugular vein; investigators performed a saline flush test and performed thorax evaluation for pleural sliding and pleural point with US and chest x-ray (CXR). Objetive is to compare successful venous placement and immediate detection of complications derived from NTC placement with US and CXR.

Results

113 patients were involved, 60% in the emergency room. Their mean age was 50 years, 62% were male. The main causes of NTHC placement were uremic syndrome (41%) and fluid overload (28%). The mean blood urea nitrogen was 111 mg/dL. The correct NTC placement was documented in all patients when the US and CXR were used. The agreement between US-guided protocol and CXR protocol is good (Kappa= 1). Only 1 pneumothorax developed, correctly detected in the US-guided protocol, with a high NPV (100%). The median evaluation time for US and CXR were 3 and 37 minutes, respectively; median difference of 34 minutes (p <0.0001).

Conclusion

The US is an effective tool for the assesemnt of adequate NTC placement and immediate complications detection in patients with urgent need of hemodialysis when compared to CXR.