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Vloga ultrazvoka pri žilnih pristopih za hemodializo
Buturović-Ponikvar, Jadranka
Ultrasonography has an increasing role in vascular access for hemodialysis. When hemodialysis catheters are concerned, ultrasonography can be used before classical landmark insertion to assess the ...anatomy of jugular veins (that is atypical in up to 25% of cases), thus avoiding unnecessary punction. The better option is to insert hemodialysis catheters under real-time ultrasound guidance, either with a free-hand technique or with needle- guide. Such insertion reduces the number of punctures, enables the pucturing of targeted vein with one puncture in the majority of patients and is safer and easier forthe less experienced physician. It should be the standard for at least jugular vein insertion. The possible long-term benefit should be explored. As arteriovenous fistula and grafts are concerned, the role of ultrasonography can be divided into three parts: a) preoperative mapping aimed to explore patients arteries and veins of both arms and suggest the type and best position of arteriovenous fistula construction b) to examine functioning arteriovenous fistula and graft with a clinical problem c) to assess thrombosed arteriovenous fistula or graft and suggest the best salvage procedure. At present, angiography of vascular access should be reserved for imaging of central veins and interventional procedures.
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