Utilidad del ecógrafo portátil en la sala de hemodiálisis para el cambio del tipo de acceso vascular: de catéter venoso tunelizado a fístula arteriovenosa

Abstract

Objective: To determine the utility of vascular ultrasound/Doppler in the hemodialysis unit about the identification of patients with tunneled venous catheter, who can be candidates for an arteriovenous fistula.
Material and Method: Cross-sectional descriptive study in patients on chronic hemodialysis with tunneled venous catheters. Evaluations were carried out by B mode portable ultrasound, in 3 different points of both arms (proximal, middle and distal), and on 2 points of both forearms (proximal and distal), collecting an average in such determinations. Qualitative morphological parameters (presence/absence of arterial calcification)and quantitative parameters (diameter and depth) of the radial, humeral and basilic veins of both upper extremities were collected.
Results: Of the 63 people on hemodialysis, 9 were carriers of a tunnelled jugular catheter (14.3%). The mean values of diameter and depth (mm) were the following: 4.7±3.0 and 9.2±2.7 (right humeral artery), 4.8±0.6 and 10.5±3.3 (left humeral artery), 2.6±0.4 and 6.6±2.0 (right radial artery), 2.7±0.7 and 6.0±1.6 (left radial artery), 4, 3±0.6 and 10.1±2.1 (right basilic vein), 5.1±0.5 and 10.1±2.1 (left basilic vein). In the majority of cases (66.7%), absence of calcifications was evidenced, an isolated plaque of calcification in one case (11.1%) and more than one in two cases (22.2%).
Conclusion: The portable ultrasound system used “in situ” in the HD unit is a useful exploration to achieve a change in the type of vascular access, that is, for the conversion of a tunneled venous catheter to an arteriovenous fistula in people with chronic hemodialysis.