Agitated saline bubble-enhanced ultrasound to visualize appropriated position of hemodialysis catheter: does catheter venous site matter

ABSTRACT

Background: The hemodialysis non tunneled catheter (HDC) is the most common access of starting renal replacement therapy. Malposition of catheter is associated with delays in treatment. Agitated saline bubble-enhanced ultrasound (SBUS) has become a new method to visualize the HDC position. Delayed appearance of microbubbles (≥2-second) in the right atrium indicates malposition. Our objective is to analyze the accuracy of SBUS between right and left internal jugular vein (IJV) HDC insertion, comparing to chest radiography (standard method). Methods: From December 2019 to May 2021, we evaluated 145 hospitalized patients submitted to HDC insertion in IJV. We compared SBUS with chest radiography (CR);the time spent to perform the CR;complications;patient characteristics;catheter blood flow and quality of dialysis. Results: Total of 145 patients were analyzed, the median age was 62 years old [50.5-70], and there was no statistical difference between the site of insertion. In RIJV, 91% catheters were placed. AKI was more frequent than CKD (75% vs 25%), except when the site was LIJV (46% vs 54%, p<0.05). AKI-related COVID-19 was the most common etiology (54%). The confirmation of catheter placement by SBUS was correlated with position by CR (All r=0.6603, p<0.0001;RIJV r=0.7044, p<0.0001;LIJV r=0.6396, p=0.0769). SBUS was highly accurate in identifying adequate location of HDC, especially in RIJV (All 97.9%;RIJV 99.2%;LIJV 84.6%, p< 0.05). The time of the catheter insertion to perform radiography was 191 minutes [83.5-287]. Adequate syringe blood flow and an effective hemodialysis session was more frequent in RIJV catheter (99.2% vs 53.8%, p<0.05;96.8% vs 72.7%, p <0.05, respectively). Complications occurred only in 4.2%, without statistical difference between catheter sites. Conclusions: Comparing with chest radiography, agitated saline bubble-enhanced ultrasound was more accurate in identifying adequate placement of RIJV than LIJV hemodialysis catheters.