Bedside placement of tunneled dialysis catheters without fluoroscopy
Abstract:
Background: Guidelines recommend fluoroscopic guidance for tunneled hemodialysis catheter placement, but fluoroscopy is costly, not universally available, and increases patient radiation exposure. Ultrasound-guided bedside placement by nephrologists, using anatomical landmarks, may provide a safe and cost-effective alternative. To evaluate the immediate safety and outcomes of nonfluoroscopic right internal jugular vein tunneled catheter placement performed by nephrologists in a tertiary care center.
Methods: Conducted a retrospective analysis of all tunneled dialysis catheters placed bedside at our center between January 2021 and December 2022. Ultrasound was used for venous cannulation, anatomical landmarks for surface marking, and postprocedure chest radiography for tip confirmation. The primary outcome was procedure-related complications within 24 h. Access failure, defined as the inability to use the catheter for dialysis within 24 h, was the secondary outcome.
Results: Among 235 patients (77.4% male; mean age 55.8 years), 7 (2.9%) developed immediate complications. Minor exit-site bleeding occurred in four patients (1.7%), all managed conservatively; two received fresh frozen plasma. Catheter malposition occurred in two cases (0.85%); one required repositioning and the other replacement with a femoral catheter. One patient (0.4%) had a cardiac arrest attributed to acute coronary syndrome unrelated to the procedure. Access failure occurred in one case (0.4%). All remaining catheters functioned successfully for immediate dialysis.
Conclusion: Ultrasound-guided, nonfluoroscopic bedside placement of right internal jugular vein tunneled catheters by nephrologists is feasible, safe, and cost-effective. This technique reduces radiation exposure and costs, supporting its role in resource-limited settings. Prospective multicenter studies are warranted to assess long-term patency, infection rates, and dialysis adequacy.
Reference:
Ganesh Srinivasa Prasad P, Aravind Sarvepalli, Limesh M, Vinod Nagesh, Nitin Kumar Hegde. Bedside Placement of Right Internal Jugular Tunneled Dialysis Catheters by Nephrologists Without Fluoroscopy: Safety and Outcomes From a Retrospective Single-Center Study. Hemodial Int. 2026 Jun 14. doi: 10.1111/hdi.70097. Epub ahead of print. PMID: 42289184.