The role of real-time ultrasound and physical examination measurements in placement of cuffed-tunneled hemodialysis catheters.

The portability of non-invasive ultrasound has resulted in an expansion of its utilization into a variety of clinical settings. Since ultrasound is recommended for initial vein cannulation during catheter placement, it is conceivable that ultrasound may also be used to verify catheter position. The purpose of this study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy. Determination of appropriate catheter length using physical exam measurements and verification of correct placement using portable ultrasound were examiner. A total of 61 subjects, 31 with and 30 without a tunneled hemodialysis catheter underwent echocardiographic examination using the SONOSITE 180PLUS (HCU; Bothell, WA) portable ultrasound. The investigator, using dynamic ultrasound imaging, was able to identify correct position in 30 of the 31 subjects with catheters. Still echocardiographic images were reviewed by two cardiologists and determined to be inconclusive. Physical examination measurements correlated well with the interventional radiologist guide-wire measurements (p <.01; r = 0.65) and concluded to be a useful method for determining appropriate cuffed catheter length. [ABSTRACT FROM AUTHOR]