Patients on hemodialysis have to undergo vascular access procedures, typically arteriovenous fistulas or arteriovenous grafts. Some, though, are limited to tunneled cuffed catheters due to heart failure or poor cardiac reserve. Properly placing tunneled cuffed catheters can be challenging and failures can lead to serious complications such as clots and central vein thrombosis, in addition to having to repeat the placements.
At the Okayama University in Japan, clinical researchers have developed a tool that helps to accurately place dialysis catheters and avoid repeat procedures. This can reduce the burden on patients, lower radiation exposure, since X-rays are often required during placement, and save clinics money in the process.
The difficulty arises from the fact that patients’ bodies have different sizes and proportions, so the new device aims to overcome this matter and make catheter placement a bit more routine.
It’s a flexible band, made from expanded polytetrafluoroethylene (ePTFE), with holes placed one centimeter apart. The holes serve as indicator spots through which a clinician can, using a marker, indicate where the entry and exit catheters need to be inserted. Because the holes are regularly spaced, the error can be no more than one centimeter.
To use, one end of the device is placed so that it runs along the right side of the heart. This is pretty easy because its radiopaque markers can be easily seen under X-ray. Once in place, marks can be made through the holes and the catheters placed as required. A follow up X-ray is used to confirm everything went well.
In a study on ten hemodialysis patients who were followed for two months after placement, none of the catheters had to be removed and replaced.
The researchers look forward to larger studies on the device and believe that the same approach can be used in other clinical areas where accurate catheter placement is key.
Study in The Journal of Vascular Access: New insertion support device assisted the accurate placement of tunneled cuffed catheter: First experience of 10 cases…
Via: Okayama University…