Ultrasound-guided brachial venous cannulation as a novel venous needle site in hemodialysis patients

Abstract

Generally, hemodialysis patients with a subcutaneously fixed artery proceed to arteriovenous graft implantation when their superficial veins are exhausted. Inserting a double lumen hemodialysis catheter, however, could be disadvantage in terms of infection control once the graft has failed due to infection. Under real-time ultrasound guidance, we repeatedly cannulated the brachial vein in two patients whose graft failed due to infection and succeeded in avoiding the insertion of a double lumen catheter until the infection was controlled. Tips for ultrasound-guided cannulation are as follows : 1) Locations of the brachial vein, artery and nerve were fully observed in advance. 2) After the brachial vein was visualized on short axis view, the ultrasound probe was slanted and set perpendicular to the hemodialysis needle, which improved visualization of the needle echo, resulting in precise identification of the needle tip location. 3) After successfully inserting the needle tip into the venous lumen, the probe and the needle were reciprocally advanced little by little in order to avoid injuring the vessel wall. As a result, we performed 51 brachial vein cannulations in these two patients with a 100% cannulation success rate and 0% arterial puncture and nerve injury rates. In conclusion, in patients with a subcutaneously fixed artery and exhausted veins, the brachial vein can be repeatedly cannulated under ultrasound guidance until another vascular access is established, making this route especially useful in cases of infection.