Tunneled hemodialysis catheter insertion: Above, within, or below the right atrium-Where is the tip?

IF 0.9 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Acta radiologica open Pub Date : 2022-09-01 DOI:10.1177/20584601221122421
Jonas Auer, Joachim Braun, Julian Lenk, Johannes Gollrad, Sa-Ra Ro, Bernd Hamm, Maximilian de Bucourt
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Abstract

Background: One major challenge when inserting a tunneled, cuffed central venous catheter (CVC) for hemodialysis under fluoroscopy is to accurately place the catheter tip by assessing its position in relation to the cardiac silhouette to approximate the right atrium (RA).

Purpose: To investigate whether a weighted mean calculated from published results for two two-dimensional landmark reference distances may be useful in assessing CVC tip positions in relation to the RA.

Material and methods: Central venous catheter tip positions attained under fluoroscopic imaging during insertion using the cardiac silhouette as approximation were retrospectively related to two reference distances (carina to cranial RA border and craniocaudal RA extent), which were used to group catheter tip locations above (1), within (2), or below (3) the RA (henceforth referred to as landmark technique approximation, LTA). The LTA-derived catheter tip locations were validated by correlation with postinterventional computed tomography (CT) datasets acquired shortly after implantation (if available).

Results: Based on LTA, 45 catheter tips (10.6%) were above, 179 (42.2%) within, and 200 (47.2%) below the RA. Postinterventional CT (n = 57; 13.4%) visualized 26.3% above, 66.7% within, and 7.0% below the RA.

Conclusion: The LTA reference distances appear to lead to a rather low categorization of the CVC tips, or the tips have been placed rather low in the study population. Validation using postinterventional CT indicated an underestimation of the RA in the LTA. Patient characteristics with a higher risk of false estimation through LTA have been defined.

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隧道式血液透析导管置入:右心房上方、内部或下方——导管尖端在哪里?
背景:在透视下插入用于血液透析的隧道式中心静脉导管(CVC)的一个主要挑战是通过评估导管尖端与心脏轮廓的关系来准确放置导管尖端,以接近右心房(RA)。目的:研究两个二维地标参考距离的加权平均值是否可用于评估与RA相关的CVC尖端位置。材料和方法:在插入过程中,使用心脏轮廓作为近似,在透视成像下获得的中心静脉导管尖端位置与两个参考距离(隆突到颅侧RA边界和颅侧RA范围)回顾性相关,这些参考距离用于将导管尖端位置分组在(1)之上,(2)之内或(3)之下(以下称为地标技术近似,LTA)。lta衍生的导管尖端位置通过与植入后(如果可用)获得的介入后计算机断层扫描(CT)数据集的相关性进行验证。结果:基于LTA,导管尖端在RA以上的有45个(10.6%),在RA以内的有179个(42.2%),低于RA的有200个(47.2%)。介入后CT (n = 57;13.4%)高于RA 26.3%,低于RA 66.7%,低于RA 7.0%。结论:LTA参考距离似乎导致CVC提示的分类相当低,或者提示在研究人群中的位置相当低。介入后CT验证显示低估了LTA的RA。已经定义了通过LTA进行错误估计风险较高的患者特征。
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