Abstract:
Background: Reliable vascular access is essential for hemodialysis. While arteriovenous fistulas are preferred for long-term use, tunneled hemodialysis catheters (TDCs) remain necessary, especially in urgent settings or when fistula creation is not feasible. Fluoroscopy is traditionally used to confirm catheter tip placement, but limited access and higher costs can be barriers. This study evaluated the safety and feasibility of fluoroscopy-free TDC placement using ultrasound and anatomical landmarks.
Methods: We performed a retrospective analysis of 266 TDC insertions between 2018 and 2023 at a single center. All procedures were ultrasound-guided with landmark-based planning. Post-procedural imaging verified tip position, and any malposition prompted immediate repositioning. Data collected included insertion site, patient demographics, incident vs. prevalent dialysis status, complications, and need for repositioning.
Results: The median patient age was 65 ± 15 years, with 58% male. Most catheters were placed via the internal jugular vein (91.7%; 223 right, 21 left). Femoral access was used in 7.9% and subclavian in one case. Bleeding complications were infrequent and occurred in 4% of cases. There was also a single instance of inadvertent carotid artery puncture, successfully managed without major intervention. Tip repositioning was required in 11% of internal jugular placements; repositioning assessment was not applicable for femoral access. Comparative analysis showed no significant differences in bleeding rates or need for repositioning between right and left internal jugular vein insertions.
Conclusions: Ultrasound and landmark-guided TDC placement without fluoroscopy proved safe and effective, with low complication rates and reliable function. These findings support fluoroscopy-free approaches as practical alternatives, especially in settings with limited imaging access.
Clinical trial number: Not applicable.
Reference:Kakareko K, Kwiatkowska K, Rydzewska-Rosolowska A, Glowinska I, Hryszko T. Fluoroscopy-free insertion of tunneled hemodialysis catheters: ensuring safety and precision – a retrospective observational study. BMC Nephrol. 2025 Nov 26;26(1):672. doi: 10.1186/s12882-025-04610-5. PMID: 41299304; PMCID: PMC12659085.