Zaghloul gouda minia 2018

Minia faculty of medicine
Minia Nephrology Department Workshop
In collaboration with
New Mansoura International Hospital
Hospital Information System (HIS)
Supporting Egyptian Nephrology Departments Administrative System
www.telekidney.com/his
HIS Made Easy Program
Zaghloul Gouda
Nephrology Department,
Damanhour Medical National Institute

HD Catheters
Technical Tips
Zaghloul Gouda
Nephrology Department,
Damanhour Medical National Institute

Vascular Access
www.hd-cath.com
• HD CATH Program
NCDs Prevention
www.telekidney.com
• NCDs Prevention Clinic
Education
www.telekidney.com/e
du
• Community Members eg:
WKD
• Patients
• Physicians, Dietitian &
Nursing Staff
• Healthcare Providers
Hospital
Information System
(HIS)
www.telekidney.com/h
is
• Inpatient Department:
• Nephrology Inpatient
• Nephrology
Consultations
• HD Unit
• PD
• Transplantation
• OPD:
• Nephrology Clinic
• Vascular Access Clinic
• Research:
• Nephrology Research
• NCDs Research
Nephro Made Easy Program

NCDs Prevention
www.telekidney.com

Education
www.telekidney.com/edu

Hospital Information System
(HIS)

Receive your brochure from the desk outside the conference room

Case Series
Poor HD vascular Access
www.hd-cath.com www.telekidney.com

Case Presentation – 1
62 ys old female on longstanding RHD through multiple AVFs referred to us for
insertion of cuffed HD catheter due to failed AVF.
USS Doppler of central venous system:
• Obstruction of both IJVs and dilated superficial venous system allover the chest
which may be a sure sign for SVC obstruction.
• Obstructed both femoral veins.
Ext Iliac – IVC Approach
• Obstructed right Ext iliac vein
• Patent Lt Ext Iliac vein.

Case Presentation – 1 : Ext Iliac – IVC Approach

55 ys old male on longstanding RHD through multiple AVFs referred to us for
insertion of cuffed HD catheter due to failed AVF.
USS Doppler of central venous system:
• Obstruction of both IJVs.
• Obstructed both Ext Iliac veins.
Rt Low Internal Jugular Vein Approach

22 ys old female, ESRD on RHD since 10 years through Lt brachiocephalic AVG
in Damanhur Nephrology department.
Swallen Lt arm and difficult cannulation
of the graft during HD.
Congestion of LT ext jugular vein.
Appearance of collateral veins in the Lt
arm and shoulder.
Occasional increase in venous pressure
during HD.
Rt and Lt IJVs temporary HD
catheters at the start of HD.
Rt brachiocephalic AVF failed
after 3 years of HD.
Current Lt brachiocephalic AVG
Complain/Examination HD access history

Central Venous Anatomy

Left Brachiocephalic AVG Antegrade Venous Puncture :
• Appearance and congestion of the Hemi-azygos vein and venous collaterals.
• Retrograde reflux of the dye in the Rt IJV.
• Tight stenosis at the confluence of the brachio-Cephalic vein.

Central venous angioplasty
Balloon angioplasty using 14 mm high pressure balloon

Very good result:
• Disappearance of the Hemi-azygos vein and venous collaterals.
• Disappearance of the retrograde reflux of the dye in the Rt IJV.
Post central venous angioplasty

63 ys old male on longstanding RHD with no vascular access referred to us obligatory
for CAPD with no HD for 10 days due to no access. Patient presented by DLC, severe
metabolic acidosis and impending pulmonary edema.
Exam:
- Failed multiple AVFs
- USS Doppler of central venous system: Obstruction of both IJVs & both Ext Iliac
veins.
Plan: Lt retrograde femoral vein temporary catheter and 2 SLED sessions until referral
to interventional radiology.

10 Technical Tips
HD Catheters

Technical Tip-1:
Land Mark of IJV: Short/Long Neck

Technical Tip-2:
Length/French of Cuffed Catheters:
 Length:
• Rt IJC: 24, 28 cm
• Lt IJC: 28, 32 cm
• Rt femoral/iliac CATH 36, 42 or 55 cm
• Lt femoral/iliac CATH 55 cm
There are many variations according to patient size and CATH availability
• Rt IJV CATH (24 cm), French 14 or more
• Other approaches at least 15 French
 French:

Technical Tip-3:
Catheter Tip Position
J Res Med Sci. 2013 May;18(5):383-6:
The mid-sternal length, a practical anatomical landmark for
optimal positioning of long-term central venous catheters.
Salimi F, Imani MR, Ghasemi N, Keshavarzian A, Jazi AH.

Technical Tip-4:
Local Anesthesia

Technical Tip-5:
Blind Vein localization

Technical Tip-6:
The guide wire can not proceed in femoral and
internal jugular catheters

Technical Tip-7:
Subclavian catheters

Technical Tip-8:
Stitch of HD Catheter
IJV Catheter – Parallel to the catheter long axis
Femoral Catheter – Perpendicular to the catheter long axis

Technical Tip-8:
Stitch of HD Catheter

Technical Tip-9:
Leakage of blood from the exit site.

Technical Tip-10:
Infection control

Home Message
HD Vascular Access

50
Stage 1&2
Stage
3a,b
Stage 5
Stage 4
30 ml/min
Inform
1- You have reduced kidney
function and you may need
kidney replacement therapy
(KRT) to save your life.
2- Describe modalities of KRT.
3- Spare forearm and upper
arm veins from injections.
Dorsum of hands is the
preferred site for injections and
cannulation. This will save
these veins for creation of AVF.
20 ml/min ……. Create
This is the optimal time for creation of AVF/
preparation for preemptive kidney
transplantation

Change Concepts
for Increasing AV Fistulas

www.hd-cath.com
Register to receive your
FREE trial version

THANK YOU
''Fistula First,
Catheter
Last''

Zaghloul gouda minia 2018

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