Troubleshooting Technique for Hemodialysis Catheter Insertion...Troubleshooting Technique for Hemodialysis Catheter Insertion . ... Doppler Ultrasound improve success. Short and long
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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
Troubleshooting Technique forHemodialysis Catheter Insertion
Troubleshooting
Finder Needle 1.5 ’’ length
Difficulty feeding the Guidewire
Poor Arterial Channel Blood Flow
Poor Arterial BFR DLC : Kinking ,Intraluminal Clot and Sucking Wall SUCKING WALL : Turn the Catheter 180 º
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
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
–Internal jugular vein.(Rt) first
–External jugular vein.
–Subclavian vein.(Supraclav.)
–Femoral vein.
–Subclavian vein (Infraclav.)
Sites of Cannulation:
very important
Permcath(TCC)insertion technique and instrument
Anatomical landmark
Position
Modified Seldinger technique
Selection of appropriate size and length
Ultrasound with vascular probe
Fluoroscopy
Annals Surgical Treatment
and Research 2015;88(2):114-117
Cutting Edge Vascular Access Masters Course |
Wednesday, February 15, 2017 40
Cutting Edge Vascular Access Masters Course |
Wednesday, February 15, 2017 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, 2017 42
Long axis in-plane
Short axis lateral in-plane
Short axis, Out-of-Plane
Vertical(Anterior) approach
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)
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