Step 5: We use the standard tunneller tool inside the kit to make the subcutaneous tunnel of the catheter.Step 6: Gradual, gentle and rotatory dilatation of the deep track is ensured after injecting local anesthesia deep till the wall of the liver.Step 7: We insert the catheter over the peelable sheath, or over the wire or both simultaneously.We ensure adequate blood flow though the catheter and a make the final fixation suture and dressing.Step 8: Tip location of the catheter in the right atrium or the atriocaval junction is ensured using ultrasound machine.A final x-ray is obtained to confirm tip location and kink free insertion.Figure 5 Results: Seven out of 8 attempts were inserted successfully with tip in position and demonstrated excellent blood flow rates during hemodialysis sessions.Duration of catheter use ranged from 60 -1230 days.Two catheters were exchanged over a guidewire.The first one was exchanged due to presence of blood stream infection with a fungal organism after 115 days, and the other due to tip migration after 60 days.Conclusion: Ultrasound guided insertion of transhepatic hemodialysis catheter with post-insertion x-ray is a safe, affective and lifesaving technique with favorable outcomes if done by well-trained nephrologists.It should be done if there is a lack of c-arm facilities as an emergency for certain patients.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Esteban-Prado et al. (Wed,) studied this question.