Tunnelled dialysis catheters (TDCs) are key as an interim for haemodialysis until an atrio-venous fistulae matures. Repeated ultrasound-guided insertion of medical TDCs causes stenosis of the vein warranting a surgical cut-down. In these narrow veins, a single cut-down renders them no longer suitable for further use. We devised a method permitting repeated insertions using the omohyoid muscle as a marker. The TDC can be initially inserted above the muscle (I), followed by dividing the muscle (II) and finally below this muscle (III) as shown in Figure 1. In our experience, this permits repeated successful insertions, as the next re-insertion is centrally more proximal to the previous insertion away from the stenosis.
Figure 1.
Diagram illustrating proposed technique.