• Kannaiyan Samuel Rabindranath, Emil Kumar, Ranjit Shail, and Emma Vaux.
• Renal Unit, New Cross Hospital, Wolverhampton, United Kingdom. ksrabi@yahoo.co.uk
• Am. J. Kidney Dis. 2011 Dec 1;58(6):964-70.

BackgroundInsertion of percutaneous hemodialysis catheters is an invasive procedure with a small but definite risk of morbidity and mortality.ObjectivesAssessing potential benefits of using real-time 2-dimensional Doppler ultrasound imaging guidance for the insertion of hemodialysis catheters compared with insertion based solely on anatomic landmarks.Study DesignSystematic review and meta-analysis of randomized controlled trials.Data SourcesMEDLINE (1966 to July 2010), EMBASE (1980 to July 2010), Cochrane Renal Group Specialised Register, and Cochrane Central Register of Controlled Trials (CENTRAL).Setting & PopulationPatients requiring hemodialysis catheter insertion.Selection Criteria For StudiesWe included all randomized controlled trials regardless of publication status or language.InterventionsReal-time 2-dimensional Doppler ultrasound image guidance.OutcomesCatheter placement failures, catheters failed to be placed in the first attempt, attempts per catheter inserted, time taken for successful venous puncture, and complications (carotid artery puncture, pneumo- or hemothorax, neck hematoma, and brachial plexus injury). Treatment effects were summarized with the RR measure for dichotomous outcomes and mean difference for continuous outcomes.Results7 trials with 830 catheters were identified. Ultrasound guidance significantly decreased the risk of the following outcomes: catheter placement failure (7 studies, 830 catheters; RR, 0.12; 95% CI, 0.04-0.37), failure to place catheter on first attempt (5 studies, 595 catheters; RR, 0.40; 95% CI, 0.29-0.56), arterial punctures (6 trials, 785 catheters; RR, 0.22; 95% CI, 0.06-0.81), and hematoma formation (4 trials, 323 catheters; RR, 0.27; 95% CI, 0.08-0.88). It also significantly decreased the time to cannulate the vein (1 trial, 73 catheters; mean difference, -1.40; 95% CI, -2.17 to -0.63), and number of attempts per catheter insertion (1 trial, 110 catheters; mean difference, -0.35; 95% CI, -0.54 to -0.16).LimitationsOnly 7 studies were identified, of which 3 were reported in only a conference abstract form. Some outcomes were reported in only 1 study.ConclusionsUse of real-time Doppler ultrasound guidance has benefits with respect to several important clinical outcomes, and its routine use in the insertion of hemodialysis catheters is strongly recommended.Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

11 keywords...

hide…