Troubleshooting Technique for Hemodialysis Catheter Insertion

Transcription

1 Troubleshooting Technique for Hemodialysis Catheter Insertion Withoon Ungkitphaiboon Assistant Professor, Department of Surgery, Maha Chakri Sirindhorn Medical Center Srinakharinwirot University Present in One-day in Vascular Disease #11 4 Feb 2560

2 Troubleshooting Finder Needle 1.5 length Difficulty feeding the Guidewire Poor Arterial Channel Blood Flow

3 Partial: Tenting

4 Partial Free blood aspiration Failure to insert Guidewire into Venous lumen

5 Partial Free blood aspiration Failure to insert Guidewire into Venous lumen

6 Complete Bevel of Needle

7 Complete

8 90 degree rotation of Needle : Bevel direction to the Heart Heart

9 Insert Guidewire to GUIDEWIRE

10 Poor Arterial BFR DLC : Kinking,Intraluminal Clot and Sucking Wall SUCKING WALL : Turn the Catheter 180 º

11 Position: Medial Venous ch. 180º SVC A V

12 Lateral approach : Maxid Permcath insertion

13 How to get best result with Catheter insertion? Withoon Ungkitphaiboon Assistant Professor, Department of Surgery, Maha Chakri Sirindhorn Medical Center Srinakharinwirot University Present in One-day in Vascular Disease #11 4 Feb 2560

14 Best Function, Lowest Complication : due to 1. Tip : Good Position : Good design : No sucking wall 2. Curve : Anti-kinking : Material : High or Low insertion : Lateral or Anterior approach 3. Diameter Large or Small 4. Length of Catheter selection

15 Curve Size Tip

16 Sites of Cannulation: very important Internal jugular vein.(rt) first External jugular vein. Subclavian vein.(supraclav.) Femoral vein. Subclavian vein (Infraclav.)

17 Preop. Assessment Short Neck Short Neck

18 Thyroid Enlargement

19 Previous puncture

20

21 Dilatation of superficial vein

22 Central Vein stenosis Previous Central line or DLC insertion

23 Failure cannulation before

24 Preop. Imaging: CTV & MRV

25 Brachiocephalic vein occlusion

26 MRV Central Vein of chest

27 Permcath(TCC) insertion technique and instrument Anatomical landmark Position Modified Seldinger technique Selection of appropriate size and length Ultrasound with vascular probe Fluoroscopy

28 Set of Mahurkar temporary double lumen HD cath.

29 Instrument

30 Doppler US(Vascular)& Fluoroscopy

31 Fluoroscopy

32 Doppler Ultrasound improve success

33 Short and long axis

34 Short Axis

35 Short Axis SCM

36 Long Axis : Needle

37 SHORT AXIS Ultrasound view

38 SHORT AXIS Ultrasound view

39 Short Axis Vertical out-of-plane technique

40 Annals Surgical Treatment and Research 2015;88(2): Cutting Edge Vascular Access Masters Course Wednesday, February 15,

41 - Traditional Out-of-plane/Short axis - Lateral in-plane/short axis (Lateral short axis in-plane) Cutting Edge Vascular Access Masters Course Wednesday, February 15,

42 Short axis, Out-of-Plane Vertical(Anterior) approach Long axis in-plane Short axis lateral in-plane Cutting Edge Vascular Access Masters Course Wednesday, February 15,

43 Short Axis, Lateral in Plane technique

44 Internal jugular vein(right) Sedillot s triangle

45 Sedillot triangle

46 Internal jugular vein insertion(left) High insertion Middle insertion Low insertion

47 Cross section of internal jugular vein

48 Approach to int.jugular vein

49 Ultrasound view SCM Anterior Lateral

50 Lateral approach Anterior approach

51 High Insertion

52 External jugular vein Curve into Medial

53 External jugular vein

54 Femoral Vein

55 Common Site of Puncture 1 1.(Anterior) IJV. 2.(Infraclavicular) Subclavian V. 2

56 Subclavian Route No need to position in Trendelenberg Place small towel roll between scapulas(infraclavicular) Abduct arm to flatten deltoid bulge(infraclavicular) Abduct arm and pull toward down to foot(supraclavicular)

57 Infraclavicular subclavian V Mid clavicular

58 Supraclavicular subclavian V.

59

60 Subclavian V - Int Jugular V Junction CCA

61 Approach to supraclav. subclavian

62 Advantages of Supraclavicular subclavian approach No need for Trendelenberg No need for Head turn Lower incidence of Central vein stenosis than Infraclavicular approach Most successful Can use U/S to find vein