Feasibility and Safety of bedside placement of tunneled dialysis catheters: A systematic review and meta-analysis of prevalence.

Abstract

Tunneled dialysis catheters (TDCs) are typically the vascular access of choice for critically ill patients in need of urgent dialysis for prolonged periods of time. The standard of practice is to insert these catheters under fluoroscopic guidance to ensure proper catheter placement in the cavo-atrial junction or right atrium. However, there is increasing interest in bedside placement of TDCs without fluoroscopic guidance in patients deemed too critically ill to be transported to the fluoroscopy suite or operating room. Our aim was to systematically review the literature on bedside placement of TDCs and to calculate the pooled prevalence rates of technical success, favorable clinical outcomes, and overall complications. We searched PubMed and Google Scholar for articles on bedside insertion of TDCs without setting a specific timeframe. We stratified the articles based on the risk of publication bias. Data on technical success, favorable clinical outcomes and complications were collected. A total of 22 articles were included, comprising 1546 TDCs inserted at bedside. The technical success rate was found to be 97.2% [95% CI: 94.6 - 98.9%; I2 = 77.5%]; LFK index = -0.72 and favorable clinical outcome was reported in 97.6% [95% CI: 94.5-99.5%; I2 = 84.8%]; LFK index = -1.62. The pooled prevalence of complications was found to be 6.98% [95% CI: 3.12 - 12.1%; I2 = 87.8%]; LFK index = 0.95, most of which were mechanical in nature. Our findings suggest that bedside placement of TDCs is a technically feasible procedure with high favorable clinical outcomes and comparable complication rates to the conventional method of TDC insertion under fluoroscopic guidance. Several non-fluoroscopic techniques have also been suggested to confirm the proper positioning of the catheter in the right atrium. These findings may challenge the gold standard of utilizing fluoroscopic guidance for TDCs.