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Conventional venous catheters are usually placed in jugular or femoral veins to provide access for hemodialysis (HD). Stenosis, thrombosis, or both, of those vessels further reduces options. We present an unconventional inferior vena cava catheterization as a feasible option in patients with exhaustion of vascular accesses.
Three patients with end-stage kidney disease (ESKD) receiving hemodialysis treatment with loss of peritoneal cavity, exhaustion of vascular accesses and need for urgent HD with access devices that do not work in ordinary sites were previously included. Patency of the inferior vena cava is required to allow puncture, passage of dilators and catheter to the right atrium with computed tomography guidance.
Inferior vena cava catheters with computed tomography were successfully inserted in three patients. Mean catheter days were 2,5 ± 0,5 days with one patient having 26 catheter days. Mean blood pump velocity was 390,0±44,7 ml/min. The rate of urea and potassium reduction at 3 hours after HD session was 31% and 37.5% respectively which decreased with increasing number of sessions. The average ultrafiltration volume was 2.7 L/session. No major complications were observed during insertion or the post-insertion period, except for pain in the lumbar region in one patient. Long-term complications were observed in one patient presenting infectious endocarditis which required catheter removal.
Translumbar HD vascular access is a new, effective, and life-saving HD approach. It is indicated when there are life-threatening dialysis urgency criteria in CKD patients with veins unavailable to provide HD access. Further studies are recommended for further evaluation of this technique.