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Meta-Analysis
. 2011 Nov 9;2011(11):CD005279.
doi: 10.1002/14651858.CD005279.pub4.

Ultrasound use for the placement of haemodialysis catheters

Kannaiyan S Rabindranath  1 , Emil Kumar, Ranjit Shail, Emma C Vaux
Affiliations
Meta-Analysis

Ultrasound use for the placement of haemodialysis catheters

Kannaiyan S Rabindranath et al. Cochrane Database Syst Rev. .

Abstract

Background: A significant proportion of patients starting dialysis do so with a temporary or tunnelled haemodialysis catheter. Insertion of these catheters can be achieved either by using the anatomical landmarks for the veins into which they are inserted or using ultrasound guidance. It has been suggested that the use of ultrasound guidance reduces the immediate complications of haemodialysis catheter insertions such as pneumothorax or arterial puncture.

Objectives: The aim of the review was to compare the use of real-time 2-dimensional (2-D) Doppler ultrasound venous imaging in the insertion of percutaneous central venous catheters for dialysis versus the traditional "blind" landmark method.

Search methods: We searched the Cochrane Renal Group's Specialised Register, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL). Reference lists of identified studies and relevant narrative reviews were also screened. Search date: January 2011.

Selection criteria: All randomised controlled trials (RCTs) and quasi-RCTs evaluating ultrasound guidance in the percutaneous insertion of central venous catheters for dialysis (both cuffed and uncuffed) against the traditional blind landmark method.

Data collection and analysis: Two authors assessed risk of bias and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results: We identified seven studies enrolling 767 patients and with 830 catheter insertions. Three of seven studies described the method of random sequence generation, none described allocation concealment, and blinding of participants and personnel was not possible. Real-time ultrasound guidance was found to significantly reduce the risk of catheter placement failure on the first attempt (5 studies, 595 catheters): RR 0.40, 95% CI 0.30 to 0.52), significantly reduce the risk of arterial puncture (6 studies, 535 catheters: RR 0.13, 95% CI 0.04 to 0.37) and haematomas (4 studies, 323 catheters: RR 0.22, 95% CI 0.06 to 0.81) when compared to the landmark method. The time taken for successful cannulation was significantly lower with the use of real-time ultrasound guidance (1 study, 73 catheters: MD -1.40 min, 95% CI -2.17 to -0.63) and there were less attempts/catheter insertion (1 study, 110 catheters: -0.35, 95% CI -0.54 to -0.16).

Authors' conclusions: Use of real-time 2-D Doppler ultrasound guidance has significant benefits with respect to the number if catheters successfully inserted on the first attempt, reduction in the risk of arterial puncture and haematomas and the time taken for successful vein puncture.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram illustrating the process from literature searching to study selection
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 1 Failed catheter placement (overall).
1.2
1.2. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 2 Failed catheter placement (first attempt).
1.3
1.3. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 3 Attempts/catheter insertion.
1.4
1.4. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 4 Time for cannulation (anaesthesia to vein puncture).
1.5
1.5. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 5 Arterial puncture.
1.6
1.6. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 6 Haematoma.
1.7
1.7. Analysis
Comparison 1 Ultrasound guided versus "blind" haemodialysis catheter insertion, Outcome 7 Pneumothorax or haemothorax.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bansal 2005 {published data only}
    1. Bansal R, Agarwal SK, Tiwari SC, Dash SC. A prospective randomized study to compare ultrasound‐guided with non‐ultrasound guided double lumen internal jugular catheter insertion as a temporary hemodialysis access. Renal Failure 2005;27(5):561‐4. [MEDLINE: ] - PubMed
Ibrik 2000 {published data only}
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    1. Ibrik O, Samon Guasch R, Roca Tey R, Viladoms Guerra J. Venous cannulation of large veins for hemodialysis vascular access study of 212 catheters [abstract]. 37th Congress. European Renal Association. European Dialysis and Transplantation Association. European Kidney Research Organisation; 2000 Sept 17‐20; Nice, France. 2000:270.
Korogolu 2006 {published data only}
    1. Koroglu M, Demir M, Koroglu BK, Sezer MT, Akhan O, Yildiz H, et al. Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients. Acta Radiologica 2006;47(1):43‐7. [MEDLINE: ] - PubMed
Kumwenda 2003 {published data only}
    1. Kumwenda M. A randomised study to compare the success rate and complications of the landmark and ultrasound guide techniques of the insertion of tunnelled haemodialysis catheters in patients with end‐stage renal failure [abstract]. Journal of American Society of Nephrology 2003;14(Nov):767A.
Nadig 1998 {published data only}
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References to studies excluded from this review

Altman 1994 {published data only}
    1. Altman SD, Epstein ML, Beasley RE, Shane RW, Jamnadas P, Work J. Ultrasound guided angioplasty of hemodialysis access stenosis [abstract]. Journal of the American Society of Nephrology 1994;5(3):406.
Conz 1997 {published data only}
    1. Conz PA, Dissegna D, Rodighiero MP, La Greca G. Cannulation of the internal jugular vein: Comparison of the classic Seldinger technique and an ultrasound guided method. Journal of Nephrology 1997;10(6):311‐3. [MEDLINE: ] - PubMed
Docktor 1999 {published data only}
    1. Docktor BL, Sadler DJ, Gray RR, Saliken JC, So CB. Radiologic placement of tunneled central catheters: Rates of success and of immediate complications in a large series. American Journal of Roentgenology 1999;173(2):457‐60. [MEDLINE: ] - PubMed
Ewing 2002 {published data only}
    1. Ewing F, Patel D, Petherick A, Winney R, McBride K. Radiological placement of the AshSplit haemodialysis catheter: A prospective analysis of outcome and complications. Nephrology Dialysis Transplantation 2002;17(4):614‐9. [MEDLINE: ] - PubMed
Farrell 1997 {published data only}
    1. Farrell J, Gellens M. Ultrasound‐guided cannulation versus the landmark‐guided technique for acute haemodialysis access. Nephrology Dialysis Transplantation 1997;12(6):1234‐7. [MEDLINE: ] - PubMed
Kumwenda 1997 {published data only}
    1. Kumwenda M. Two different techniques and outcomes for insertion of long‐term tunnelled haemodialysis catheters. Nephrology Dialysis Transplantation 1997;12(5):1013‐6. [MEDLINE: ] - PubMed
Kwon 1997 {published data only}
    1. Kwon TH, Kim YL, Cho DK. Ultrasound‐guided cannulation of the femoral vein for acute haemodialysis access. Nephrology Dialysis Transplantation 1997;12(5):1009‐12. [MEDLINE: ] - PubMed
Muhm 2002 {published data only}
    1. Muhm M. Ultrasound guided central venous access. BMJ 2002;325(7377):1373‐4. [MEDLINE: ] - PMC - PubMed

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References to other published versions of this review

Vaux 2009
    1. Vaux EC, Shail R, Rabindranath KS. Ultrasound use for the placement of haemodialysis catheters. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD005279.pub3] - DOI - PMC - PubMed

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