C A Restrepo Valencia1. 1. Rts de Caldas, Hospital Santa Sofía, Hospital Infantil, Manizales, Caldas, Colombia, Sur América. carel@telesat.com.co
Abstract
OBJECTIVE: To establish if the implantation of catheters for hemodialysis in axillary veins is an acceptable alternative in patients with Acute or Chronic Renal Failure (ARF o CRF) with limitations for other type of central catheter. PLACE: Manizales City Hospital's Intensive Care Units and ambulatory procedure rooms of the Renal Unity RTS Ltda Caldas Subsidiary, Santa Sofia Hospital and Infantile Hospital. PATIENTS: All the patients with ARF or CRF, who required hemodialysis therapy, but that their pathology of base or the depletion of their classical access routes, required the implantation of catheters bilumenes by non conventional routes, during a period of 10 years that was extended from may 1997 to may 2007. METHODS: Those patients with ARF or CRF that required tracheostomy as support for ventilation due to their base illness; and those with ARF or CRF in whom the ambulatory or intra-hospital implantation of a central catheter for hemodialysis was not possible were carefully identified. The implantation of a double lumen central catheter for hemodialysis in axillary vein by palpation or anatomical guide was offered as an alternative to both the patients and their families. The procedure was practiced to those that accepted and gave their written consent; radiologically confirming its location; establishing their functionability at the time, as well as the complications associated to the procedure and it permanency. RESULTS: 27 procedures were practiced in 26 patients. Average age: 54.6 years; 9 women and 17 men. 7 of them had ARF and 19 CRF. In two patients the axillary vein puncture was not possible. Of the 25 axillary catheters that were implanted, 1 was permanent and 24 transitory. The technique was used by anatomical references in 16 patients and by palpation in 8. In the patients 15 left axillary veins were canalized unlike the remaining 10 that were right axillary veins. 18 patients presented impossibility of obtaining an alternative central venous access (different to femoral) and 7 patients required tracheostomy. The radiological location was satisfactorily confirmed in 24 procedures (96%). The amount of time the catheters were used was an average of 68.6 days; 6 patients died with the catheter in use. The main cause for the catheter's removal was the transference to peritoneal dialysis. The axillary artery was accidentally punctured in 3 patients, one of whom presented a soft tissue hematoma without a major hemodynamics repercussion; this had a spontaneous resolution in a few weeks. The venous canalization was not possible in 3 patients. CONCLUSIONS: The implantation of bilumenes catheters for hemodialysis in patients with ARF or CRF is a relatively safe alternative to consider when other classical routes have totally spent or the patients present tracheostomy.
OBJECTIVE: To establish if the implantation of catheters for hemodialysis in axillary veins is an acceptable alternative in patients with Acute or Chronic Renal Failure (ARF o CRF) with limitations for other type of central catheter. PLACE: Manizales City Hospital's Intensive Care Units and ambulatory procedure rooms of the Renal Unity RTS Ltda Caldas Subsidiary, Santa Sofia Hospital and Infantile Hospital. PATIENTS: All the patients with ARF or CRF, who required hemodialysis therapy, but that their pathology of base or the depletion of their classical access routes, required the implantation of catheters bilumenes by non conventional routes, during a period of 10 years that was extended from may 1997 to may 2007. METHODS: Those patients with ARF or CRF that required tracheostomy as support for ventilation due to their base illness; and those with ARF or CRF in whom the ambulatory or intra-hospital implantation of a central catheter for hemodialysis was not possible were carefully identified. The implantation of a double lumen central catheter for hemodialysis in axillary vein by palpation or anatomical guide was offered as an alternative to both the patients and their families. The procedure was practiced to those that accepted and gave their written consent; radiologically confirming its location; establishing their functionability at the time, as well as the complications associated to the procedure and it permanency. RESULTS: 27 procedures were practiced in 26 patients. Average age: 54.6 years; 9 women and 17 men. 7 of them had ARF and 19 CRF. In two patients the axillary vein puncture was not possible. Of the 25 axillary catheters that were implanted, 1 was permanent and 24 transitory. The technique was used by anatomical references in 16 patients and by palpation in 8. In the patients 15 left axillary veins were canalized unlike the remaining 10 that were right axillary veins. 18 patients presented impossibility of obtaining an alternative central venous access (different to femoral) and 7 patients required tracheostomy. The radiological location was satisfactorily confirmed in 24 procedures (96%). The amount of time the catheters were used was an average of 68.6 days; 6 patients died with the catheter in use. The main cause for the catheter's removal was the transference to peritoneal dialysis. The axillary artery was accidentally punctured in 3 patients, one of whom presented a soft tissue hematoma without a major hemodynamics repercussion; this had a spontaneous resolution in a few weeks. The venous canalization was not possible in 3 patients. CONCLUSIONS: The implantation of bilumenes catheters for hemodialysis in patients with ARF or CRF is a relatively safe alternative to consider when other classical routes have totally spent or the patients present tracheostomy.