Ultrasound-Guided Central Venous Catheter Placement in a Hemodialysis Unit: A Prospective Case Series and Pedagogical Experience

Abstract

Background: Central venous catheter (CVC) placement is a cornerstone procedure in acute hemodialysis units, serving as the primary vascular access for patients with acute kidney injury and for chronic hemodialysis patients without functional peripheral access. Although traditionally performed using anatomical landmarks, this approach is limited by anatomical variations and unrecognized venous thrombosis, leading to preventable complications. Methods: We conducted a prospective observational case series of 171 short-term CVC placements in adult patients at a single hemodialysis unit in Algiers, Algeria, between September 2010 and April 2011. All procedures were performed using a standardized six-step ultrasound-guided approach. Data were collected on patient demographics, indication for CVC, anatomical site, number of attempts, success rates, complications, changes in planned implantation site, and operator experience, which was categorized as 'junior' (fellow/resident) or 'senior' (attending) based on years of training and prior experience with ultrasound-guided CVC placement. Results: The internal jugular vein was the most frequently used site (81%), with the right side preferred (58%). First-attempt success rates were 87% for the right internal jugular vein and 80% for the left. Femoral vein access was successful in all cases, with a first-attempt success rate of 82% .Overall success reached 100% by the second attempt. Pre-procedural ultrasound led to a change in the planned implantation site in 56 cases (33%), primarily due to detection of thrombosis or stenosis. Major complications were minimal: arterial puncture occurred in 1.2% and hematoma in 1.8%, with no pneumothorax or deaths. Junior physicians achieved higher success rates and reported greater confidence when using ultrasound compared with historical landmark-based practice. Conclusion: Ultrasound-guided CVC placement, when performed using a systematic and structured approach, is safe, highly effective, and offers substantial pedagogical value. We advocate its routine use in hemodialysis units and recommend formal integration of ultrasound training into nephrology curricula.