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[Tunnelized double femoral catheters. A technique for vascular access in hemodialysis]
1Service de Réanimation et Transplantation, Hôpital Necker, Paris.
Insights
Double femoral catheterization offers a viable alternative for temporary vascular access in hemodialysis when the jugular route is not feasible. This method provides effective dialysis sessions without significant complications like thrombosis.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Context:
- Temporary vascular access is crucial for hemodialysis.
- Internal jugular vein catheterization is a common but sometimes contraindicated approach.
- Dialysis units face daily challenges in securing adequate vascular access.
Purpose:
- To evaluate the efficacy and safety of double femoral vein catheterization for temporary hemodialysis access.
- To assess the feasibility of using the femoral route when the jugular route is difficult or contraindicated.
Summary:
- A double catheter was percutaneously inserted into the femoral vein in 12 patients under local anesthesia.
- The mean implantation time was 45 minutes, with the ideal distal tip placement in the inferior vena cava.
- The average utilization was 41 days, supporting 28 hemodialysis sessions without reported thrombosis on follow-up Doppler examinations.
Impact:
- Double femoral catheterization serves as a practical alternative vascular access for hemodialysis.
- This technique expands options for patients unsuitable for jugular access.
- The procedure demonstrates a favorable safety profile, minimizing thrombotic complications.
Objectives:
Temporary vascular access for haemodialysis is an everyday problem in a dialysis unit. We used the double catheter method developed for the internal jugular vein to catheterize the femoral vein in patients in which the jugular route could not be used.
Methods:
A double catheter was inserted via percutaneous, bedside, punction into the femoral vein in 12 patients under local anaesthesia. The exit point was located near the middle of the thigh.
Results:
Mean implantation time was 45 minutes. The inferior vena cava was the ideal site for the distal tip of the catheters. Mean duration of utilisation was 41 days (range 6-118) and allowed a mean of 28 haemodialysis sessions (range 4-49). Echo-Doppler examinations after withdrawal did not reveal any thrombosis of the femoral, iliac or vena cava.
Conclusions:
When the jugular route is difficult or contraindicated, double femoral catheterism is a useful alternative vascular access for haemodialysis.