SHORT REPORT

Placement of
tunnelled silicone

haemodialysis
catheters in a

radiology
• • •Intervention unit

J H Bartlett
MBChB

E Loggenberg
MMedRad(D)

C S de Vries
MMedRad(D)

Department of Diagnostic Radiology
University of the Free State

Bloemfontein

As an alternative to surgical place-
ment, tunnelled haernodialysis
catheters can be placed in the sterile
environment of an interventional
unit. The same dress code and access
to the unit is used as in a sterile oper-
ating theatre.

This was a retrospective study con-
ducted over a 3-year period.
Placement was done under real-time
ultrasound guidance under sterile
conditions. Suitable venous puncture
was done and the guide wire manipu-
lated under fluoroscopy. If necessary, a
venogram may be used to determine
the patency of the vein (Figs 1 - 4) as
well as any anatomical variants or dis-
placement by tumours or masses (Fig.
.5). The catheter is then tunnelled

from a distant position on the anteri-
or abdominal wall and placed in a
central vein via a peel-away sheath
and the catheters are always manipu-
lated under fluoroscopy to determine
the optimal position (Figs 6 - 8).

Fig. 1. Internal jugular vein.

Fig. 2. Doppler flow In internal jugular vein.

After placement in the superior
vena cava, free back-flow of blood

29 SA JOURNAL OF RADIOLOGY • June 2002

Fig. 3. Determine patency of vein.

Fig. 4. Needle in internal jugular vein under ultra-
sound guidance.

Fig. 5. Venogram to determine patency of internal
jugular and superior vena cava.

should be present and a post place-
ment venogram must always be done



SHORT REPORT

Fig. 6. Guidewire through di/ator and peel-away
catheter.

to prove the patency as well as the
exact position of the line (Fig. 9).

Eight children and 52 adults
underwent the procedure. The punc-
ture areas included the right jugular
(N = 35), left jugular (N = 14), right
subclavian (N = 2), left subclavian
(N = I), left femoral (N = 4) and right
femoral (N = 4). Two patients received
multiple punctures, 2 lines were used
for 1 patient, and 6 venograms were
done. No sepsis was reported after the
follow-ups of 1 week and 1 month.

As can be seen, the right internal
jugular vein is the preferred site of
puncture because of the easier place-
ment of the guide wires and catheters
from this position.

Placement of silicone catheters in
an interventional unit is a good alter-
native to provide easily accessible
ports for haemodialysis. There is a
low complication rate, e.g. accidental

Fig. 7. Tunnelled catheter with dilator and peel-
away sheath in place.

Fig. 8. Determine the length of the catheter.

30 SA JOURNAL OF RADIOLOGY • June 2002

Fig. 9. Haemodialysis catheter in correct position.

puncture of the carotid artery or
pneumothorax, because the whole
procedure is done under direct fluo-
roscopyand ultrasound guidance. No
sepsis within 1 month of the proce-
dure was reported.