Fluoroscopically guided vs modified traditional placement of tunneled hemodialysis catheters: clinical outcomes and cost analysis.
Fluoroscopically guided vs modified traditional placement of tunneled hemodialysis catheters: clinical outcomes and cost analysis.
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荧光镜引导与改良传统隧道式血液透析导管放置：临床结果和成本分析。
DOI：
10.5301/jva.2008.642
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发表时间：
2007
影响因子：
1.9
通讯作者：
Y. Becker
中科院分区：
文献类型：
--
作者：
A. Yevzlin;G. Song;R. Sanchez;Y. Becker
隧道套囊颈内静脉导管广泛用于为血液透析提供短期至中期血管通路。NKF-K/DOQI指南规定，插入所有带套囊透析导管时必须进行X线透视。KDOQI的建议使得肾脏科医生在没有X线透视的情况下很难进行该手术。这导致不必要的等待时间和急性非隧道导管的不适当使用。本研究的目的是：1）比较透视引导与改良传统导管放置技术的结局，2）对两种技术进行成本分析。我们对在三级医院进行的202件隧道式血液透析导管进行了回顾性调查。手术数据来自威斯康星州大学医学部肾病科介入肾病手术数据库。从威斯康星州大学医院电子病历（EMR）中获得患者人口统计学资料和实验室检查结果。使用逻辑回归评价盲法与荧光透视引导置入对临床结局的影响，并根据手术侧、年龄、性别、既往导管置入史、糖尿病（DM）和术前凝血参数进行校正。在手术侧和DM方面，“盲法"与透视引导组的基线特征不同（分别为91.0%与79.6%，p = 0.02和43.30%与58.40%，p = 0.02）。非透视下放置导管与即刻成功的比值比降低相关（OR = 0.1298，CI = 0.02 - 0.71）。在盲法组与透视引导组之间，未发现严重或轻微出血并发症的差异。成本分析显示，执行非荧光技术作为首选的初始程序将代表提交给第三方付款人，包括医疗保险的总账单大幅减少。
Tunneled cuffed internal jugular vein catheters are widely used to provide short to medium-term vascular access for hemodialysis. The NKF-K/DOQI guidelines state that fluoroscopy is mandatory for insertion of all cuffed dialysis catheters. The KDOQI recommendation makes it difficult for Nephrologists to perform this procedure without access to fluoroscopy. This results in unnecessary waiting times and the inappropriate use of acute, non-tunneled catheters. The purpose of this study is: 1) to compare the outcomes of fluoroscopically guided vs modified traditional catheter placement technique, and 2) to perform a cost analysis of the two techniques. We performed a retrospective investigation of 202 tunneled hemodialysis catheters performed at our tertiary care hospital. Procedural data were obtained from the University of Wisconsin Department of Medicine, Nephrology Section Interventional Nephrology procedural database. Patient demographics, laboratory tests were obtained from the University of Wisconsin Hospital electronic medical record (EMR). Logistic regression was used to evaluate the effect of blind vs fluoro-guided placement on clinical outcomes, corrected for side of procedure, age, gender, previous history of catheter placement, diabetes mellitus (DM), and pre-procedural coagulation parameters. Baseline characteristics of 'blind' vs fluoro-guided groups differed with respect to side of procedure and DM (91.0% vs 79.6%, p = 0.02 and 43.30% vs 58.40%, p = 0.02, respectively). Non-fluoroscopic placement of catheters was associated with a decreased odds ratio of immediate success (OR = 0.1298, CI = 0.02 - 0.71). No difference in major or minor bleeding complications was discovered between the blind vs fluoro-guided group. Cost analysis revealed that performing the non-fluoroscopic technique as the preferred initial procedure would represent a substantial reduction in total bills submitted to third-party payers, including Medicare.