ULTRASOUND-GUIDED CANNULATION VERSUS THE LANDMARK-GUIDED TECHNIQUE FOR ACUTE HEMODIALYSIS ACCESS

Background. The correct placement of large-bore venous catheters plays an important role in the management of haemodialysis patients. Whilst the procedure for landmark-based placement of these catheters is well known, the technique is not without significant morbidity and mortali ty. Complications include arterial puncture, haematoma, and pneumothor ax. The procedure may be further complicated in these patients by veno us thrombosis and abnormal vein position from multiple previous attemp ts at venous access. Methods. Data on the use of ultrasound guidance v ersus anatomical landmarks for the placement of internal jugular vein (n=63) and femoral vein (n=30) dialysis access was retrospectively ana lysed over a 13-month period. Data collected included age, sex, durati on on dialysis, number of vein cannulation sets required, number of at tempts for successful cannulation, salvage of failed cannulation using landmark-based technique by ultrasound guidance, and the complication rate. Results. Internal jugular vein cannulation using ultrasound was ultimately successful in 96.67% compared to 82% in the landmark group . The vein was entered on the first attempt in 83.3% of patients with ultrasound compared to 35.9% of the landmark group (P<0.0001). Seven: patients in whom the landmark technique was unsuccessful had access pl aced under ultrasound guidance. There were fewer carotid artery punctu res in the ultrasound group (7.7 versus 0%, P= n.s.). In the femoral v ein group. the vein was entered on the first attempt in 85.7% of patie nts with ultrasound compared to 55.25% of the landmark group, (P=n.s.) .Conclusions. The use of ultrasound guidance is associated with fewer complications and is more likely to lead to cannulation of the vein at the first attempt in haemodialysis patients.