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Analysis of Early Failure of Tunneled Hemodialysis Catheters

¹ All authors: Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29th St., N.W., Calgary, Alberta T2N 2T9, Canada.

View larger version (140K): [in a new window]   Fig. 1. —Radiograph shows poor initial catheter position in 67-year-old man. Tip (arrow) of this right internal jugular tunneled dialysis catheter lies against floor of right atrium.

View larger version (155K): [in a new window]   Fig. 2A. —Catheter withdrawal resulting from pendulous breasts in 42-year-old woman. Radiograph with patient in supine position shows initial catheter position at junction (arrow) of superior vena cava and right atrium.

View larger version (133K): [in a new window]   Fig. 2B. —Catheter withdrawal resulting from pendulous breasts in 42-year-old woman. Radiograph with patient in upright position shows migration of catheter tip cephalad to junction (arrow) of innominate vein and superior vena cava.

View larger version (90K): [in a new window]   Fig. 3. —Radiograph shows central venous catheter with twist along long axis in 50-year-old woman. Note that both lumina are not visible on this radiograph. Catheter tip (arrow) is in good position.

View larger version (122K): [in a new window]   Fig. 4A. —Poor catheter orientation in 46-year-old woman. Dialysis was unsuccessful on day of insertion because of high arterial pressure. Radiograph shows arterial port against right atrial wall (arrow).

View larger version (131K): [in a new window]   Fig. 4B. —Poor catheter orientation in 46-year-old woman. Dialysis was unsuccessful on day of insertion because of high arterial pressure. Radiograph shows catheter that has been manipulated so that arterial port (arrow) is medial. Dialysis was successful after manipulation of catheter.

View larger version (73K): [in a new window]   Fig. 5. —Radiograph shows kinked catheter at apex (arrow) in 40-year-old woman. Initial dialysis session was unsuccessful. Dialysis was successful after manipulation removed kink.

View larger version (72K): [in a new window]   Fig. 6A. —Fibrin sheath formation resulting from indwelling catheter in 40-year-old man. Radiograph of contrast injection through dilator during guidewire exchange of tunneled dialysis catheter shows flow of contrast material through narrow lumen (arrow). Native superior vena cava lumen is much wider. This appearance is diagnostic for presence of fibrin sheath.

View larger version (69K): [in a new window]   Fig. 6B. —Fibrin sheath formation resulting from indwelling catheter in 40-year-old man. Radiograph after mechanical disruption of fibrin sheath shows that contrast material now fills native lumen of superior vena cava (arrow).

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