Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters

Abstract

The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, external landmark-guided technique. The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. From 1990 to January 2000, cannulation of the femoral vein was performed on 230 patients (125 male, 105 female, mean age 72 years, range 52–95 years) for temporary vascular access for hemodialysis (172 patients with acute renal failure and 58 patients in end-stage renal disease), using landmark localization with semi-rigid, uncuffed catheters. Between January 2000 and February 2001, ultrasound-guided cannulation of the femoral vein was utilized in 38 patients (20 male, 13 female, mean age 71, range 55–93 years) for temporary vascular access for hemodialysis (28 patients with acute renal failure and 10 patients in end-stage-renal failure). Uncuffed, dual-lumen silicone catheters were used. Cannulation of the femoral vein was achieved in 100% of cases using ultrasound, and in 87% using the landmark-guided technique. Using ultrasound, puncture of the femoral artery occurred in 2.6% of patients, and hematoma in 0%. Using the “blind” technique, puncture of the femoral artery occurred in 11.2% of patients, and hematoma in 3.9%. The average catheter dwell time, in accordance with NKF-DOQI guidelines, was 5 days (range 2 - 14 days) for semi-rigid catheters and 45 days (range 5–120 days) for silastic catheters. The number of complications rose significantly in the patients with semi-rigid catheters. In this group, local exit infection occurred in 105 persons (45% of cases), total catheter thrombosis in 46 (20%), bacteriemia in 28 (12%), and phlebitis of the leg in 6 (2.6%). In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cases), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure. We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.