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According to the Position Document of the Interventional Nephrology Committee and the Consensus Group for Optimization of Vascular Accesses of the Latin American Society of Nephrology and Hypertension, it is recommended that renal replacement therapy be initiated in a planned manner and in the first instance by performing a native or prosthetic AVF. However, in our clinical setting, the vast majority of patients initiate renal replacement therapy in an unplanned manner and with emergency criteria, so that in most cases their initial vascular access is a non-tunneled catheter placed by anatomical references, Although there is evidence of the benefit of ultrasound-guided placement, it is not yet widespread in our country.
It was a retrospective study in adults attended at hemodialysis department of “Hospital General Regional No.196” in Ecatepec, Mexico, from March 2022 to September 2023, with indication for initiation of renal replacement therapy in hemodialysis modality and ultrasound guided catheter placement. We record medical history and immediate catheter placement related complications.
A review of medical records identified 276 patients who initiated renal replacement therapy on hemodialysis, of whom 78 were placed under ultrasound guidance and were included to the analysis. We found a greater male gender proportion ( 61.5%) ,aged 54.19± 14.72 years (Table.1). The most frequent criteria to start renal replacement in hemodialysis was metabolic acidosis and modality transition from peritoneal dialysis (24.4%) followed by uremic syndrome (23.1%) , hyperkalemia (19.2%, anuria (5.1%) and fluid overload (3.8%). The overall success placement rate was 98% ,first attempt success rate was 79,5%, second attempt success rate 91% , and finally in one case the catheter placement was unsuccessful. The overall complication rate was 6.8% (table 2) ( hematoma : 2.6%, arterial puncture: 1.3%, Anomalous position: 1.3% and unsuccessful placement: 1.3%,) without any major complication. The most frequent site of insertion was right jugular vein (85.9%) followed by right femoral vein (9%), left jugular vein (3.8%) and one case of unsuccessful placement.
The placement of ultrasound-guided catheters in our unit demonstrated a similar success and complication rate to those reported in the international literature, making them a safe and effective option that can be rapidly implemented in our country's hospitals.