Document Type : Original Article


1 Department of General Surgery, Shahid Beheshti University of Medical Sciences, Medical School, Tehran, Iran

2 Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran


Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter.
Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury.
Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05).
Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended.


Main Subjects

1. Pereira K, Osiason A, Salsamendi J. Vascular access for placement of tunneled dialysis catheters for hemodialysis: a
systematic approach and clinical practice algorithm. J Clin Imaging Sci 2015; 5: 31. doi: 10.4103/2156-7514.157858.
2. Verrelli M. Chronic renal failure. Nephro Sci 2004; 231: 2-8.
3. Tayyebi A, Babahaji M, Sadeghi Shermeh M, Ebadi A, Eynollahi B. Study of the effect of Hatha Yoga exercises on
dialysis adequacy. Iran J Crit Care Nurse 2012; 4(4): 183-90.
4. Hassanzadeh J, Hashiani AA, Rajaeefard A, Salahi H, Khedmati E, Kakaei F, et al. Long-term survival of living donor renal transplants: A single center study. Indian J Nephrol 2010; 20(4): 179-84. doi: 10.4103/0971-4065.73439.
5. Gallieni M, Brenna I, Brunini F, Mezzina N, Pasho S, Giordano A. Dialysis central venous catheter types and performance. J Vasc Access 2014; 15 Suppl 7: S140-6. doi: 10.5301/jva.5000262.
6. Scher LA, Shariff S. Strategies for hemodialysis access: a vascular surgeon’s perspective. Tech Vasc Interv Radiol
2017; 20(1): 14-9. doi: 10.1053/j.tvir.2016.11.002. 
7. Clark E, Kappel J, MacRae J, Dipchand C, Hiremath S, Kiaii M, et al. Practical aspects of nontunneled and tunneled
hemodialysis catheters. Can J Kidney Health Dis 2016; 3: 2054358116669128. doi: 10.1177/2054358116669128.
8. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331(26): 1735-8. doi: 10.1056/nejm199412293312602.
9. Souba WW, Fink MP, Jurkovic GJ, Kaiser LP, Pearce WH, Pemberton JH,et al. ACS Surgery: Principles and Practice. 6
ed. Decker Intellectual Properties Incorporated; 2007.
10. Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, et al. Hemodialysis tunneled catheter noninfectious complications. Can J Kidney Health Dis 2016; 3: 2054358116669130. doi: 10.1177/2054358116669130.
11. Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis tunneled catheter-related infections.
Can J Kidney Health Dis 2016; 3: 2054358116669129. doi:10.1177/2054358116669129.
12. Milkowski A, Kirker A, Smolenski O, Hartwich A, Pietkun Z. Permanent catheter as an alternative vascular access for
hemodialysis. Przegl Lek 1996; 53(11): 805-10. [In Polish].
13. Legendre C, Canaud B. Permanent catheters for hemodialysis: indications, methods and results. French national survey 1998-2000. Nephrologie 2001; 22(8): 385-9.[In French].
14. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S.
hemodialysis patients. Kidney Int 2001; 60(4): 1443-51. doi:10.1046/j.1523-1755.2001.00947.x.
15. Lewis AL, Stabler KA, Welch JL. Perceived informational needs, problems, or concerns among patients with stage 4
chronic kidney disease. Nephrol Nurs J 2010; 37(2): 143-8; quiz 9.
16. Morton RL, Tong A, Howard K, Snelling P, Webster AC. The views of patients and carers in treatment decision making
for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ 2010; 340: c112. doi:10.1136/bmj.c112.
17. Kiely R. Social work practice and NKF-DOQI: Social Work Intervention and Vascular access Guidelines; Fall 2003.
18. Kaplow R, Hardin SR. Critical care nursing: synergy for optimal outcomes. 1st ed. Jones & Bartlett Learning; 2007.
19. Dix FP, Khan Y, Al-Khaffaf H. The brachial arterybasilic vein arterio-venous fistula in vascular access for haemodialysis--a review paper. Eur J Vasc Endovasc Surg 2006; 31(1): 70-9. doi: 10.1016/j.ejvs.2005.08.008.
20. Safaie M, Moieni E, Goharian V. Efficacy of saphenofemoral A-V fistula in cronic renal failure patients undergoing hemodialysis. J Shahid Sadoughi Univ Med Sci 2005; 13(1): 16-20.
21. Ghane Sherbaf F. Comparison of the complications of central vein catheters and arterio-venous fistulae in children
on chronic hemodialysis. Iran J Pediatr 2006; 16(4): 407-12.
22. El Minshawy O, Abd El Aziz T, Abd El Ghani H. Evaluation of vascular access complications in acute and chronic
hemodialysis. J Vasc Access 2004; 5(2): 76-82.
23. Shams Vahdati S. Should a double-lumen catheter be withdrawn? J Cardiovasc Thorac Res 2011; 3(3): 97-9.doi:10.5681/jcvtr.2011.021.
24. Fadaei Haghi A, Shokri R, Shams Vahdati S, Eftekhar Milani F, Tajoddini S. A catheter malpositioned patient with pain and paresthesia. Journal of Emergency Practice and Trauma 2017; 3(1): 30-1. doi: 10.15171/jept.2017.11.
25. van Loon MM, Kessels AG, Van der Sande FM, Tordoir JH. Cannulation and vascular access-related complications in
hemodialysis: factors determining successful cannulation. Hemodial Int 2009; 13(4): 498-504. doi: 10.1111/j.1542-
26. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48
Suppl 1: S248-73. doi: 10.1053/j.ajkd.2006.04.040.