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The Role of Real-Time Ultrasound and Physical Examination Measurements in Placement of Cuffed-Tunneled Hemodialysis Catheters
Carol M. Headley, Carol Lynn Thompson, Michael Carter,
Arshad Khan, and Barry M. Wall
The
portability of non-invasive ultrasound has resulted in an expansion of
its utilization into a variety of clinical settings. Since ultrasound
is recommended for initial vein cannulation during catheter placement,
it is conceivable that ultrasound may also be used to verify catheter
position. The purpose of this study was to evaluate the feasibility of
tunneled hemodialysis catheter placement without the use of
fluoroscopy. Determination of appropriate catheter length using
physical exam measurements and verification of correct placement using
portable ultrasound were examined. A total of 61 subjects, 31 with and
30 without a tunneled hemodialysis catheter underwent echocardiographic
examination using the SonoSite 180PLUS® (HCU; Bothell, WA) portable
ultrasound. The investigator, using dynamic ultrasound imaging, was
able to identify correct position in 30 of the 31 subjects with
catheters. Still echocardiographic images were reviewed by two
cardiologists and determined to be inconclusive. Physical examination
measurements correlated well with the interventional radiologist
guide-wire measurements (p < .01; r = 0.65) and concluded to be a
useful method for determining appropriate cuffed catheter length.
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| Carol M. Headley, MSN, RN, CNN, is
an Advanced Practice Nurse, Veterans Affairs Medical Center in Memphis,
TN. She is also enrolled in the Clinical Doctorate of Nursing Program
at the University of Tennessee Health Science Center. She is a past
president of the Memphis Blues Chapter of ANNA and member of the
Advanced Practice SIG as well as the Program Planning Committee.
Carol Lynn Thompson, PhD, RN, CCRN, CCNS, ACNP, FNP, FCCM, is
a Professor, College of Nursing, University of Tennessee Health Science
Center; and practices in acute care at the Veterans Affairs Medical
Center, Memphis, TN.
Michael Carter, MNSc, DNSc, is
Distinguished Professor, University of Tennessee Health Science Center,
Memphis, TN; and prior Dean of the College of Nursing.
Arshad Khan is Chief of Interventional Radiology, Veterans Affairs Medical Center, Memphis, TN.
Barry M. Wall, MD, is Associate Chief of Nephrology, Veterans Affairs Medical Center, Memphis, TN.
Acknowledgments: This study was
facilitated by funds received from the Ernestine Lowrie Memorial
Fellowship. The authors wish to acknowledge assistance received from
Mr. Jim Pruett in analysis and interpretation of data. SonoSite®
was instrumental through the provision of portable ultrasound (SonoSite
180PLUS® HCU; Bothell, WA) and offering clinical support during the
investigational phase.
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