Letter to the Editor
Assessment of tunnelled haemodialysis catheter insertion site using a thermal camera attached to a smartphone: a pilot study
Valoración del orificio de inserción del catéter tunelizado para hemodiálisis mediante el uso de cámara térmica acoplada a smartphone: estudio piloto
Francisco Valga
, Tania Monzón, Fernando Henriquez, Gloria Anton-Pérez
Corresponding author
Centro de Diálisis Avericum Dr. Negrin, Las Palmas de Gran Canaria, Islas Canarias, Spain
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This is caused by microorganisms which colonise the insertion site, the connectors and, less frequently, the infusion fluid.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We therefore believe it is important to find methods that may help to prevent this type of complication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Thermal imaging has been used in various fields to indirectly measure body temperature. In medicine, it has been used to measure the effectiveness of anti-inflammatory therapy in rheumatic diseases and in the management of chronic wounds, burns and fractures, under the premise that inflammation causes vasodilation and an increase in tissue metabolism, conditions which may promote a local temperature change.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Initially, however, its main disadvantage was the difficulty of using it in a real clinical setting due to size and cost.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To combat this, infrared cameras have recently emerged which are adaptable to <span class="elsevierStyleItalic">smartphones</span>, allowing real-time thermal measurement, in two dimensions, and at the patient's bedside. It is an objective, non-invasive and safe technique for the patient.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim was to assess differences in temperature between the catheter insertion site and the skin on the contralateral side. We used the third generation Flir-One® Pro camera (FLIR Systems, Inc., Wilsonville, OR) with a dynamic range from -20 to 400°C and a resolution of 0.1°C. We designed a descriptive observational study with 33 chronic haemodialysis patients with tunnelled jugular CVC. Three thermal photographs were taken of both the CVC insertion site and the contralateral side of the same patient at the beginning of the dialysis session, without having performed any action on the site, and the presence of classic signs of infection such as redness or exudate was taken into account.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 15 cm tripod was used for a standardised measurement, and we considered the average of the 3 temperatures obtained in the thermal images. With these values, the ratio between the contralateral temperature and that of the CVC site was calculated for each patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Our results were as follows: the mean temperature at the insertion site was 35.19 °C (±3.19 °C) and that of the contralateral side 36.21 °C (± 2.34 °C) (p = 0.008) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The mean of the ratios between the contralateral temperature and that of the insertion site was classified taking into account the presence (N = 5) or absence (N = 28) of signs of infection and the results were: 0.97 ± 0.026 vs 1.05 ± 0.104 (p = 0.035), respectively. These data imply that a potentially infected insertion site has a higher temperature than the skin on the contralateral side.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There have been no previous studies using thermal imaging to assess catheter insertion sites. However, various studies have shown the value of thermal imaging in the detection of local swelling, especially in diabetic patients<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> and, more recently, in the detection of suitable small perforating vessels for pre-surgical mapping in reconstructive surgery, with a diagnostic potential similar to that obtained by tomography.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This gives us an idea of the scope of an instrument that can detect minimal temperature changes on the body surface.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, the Flir-One® thermal camera detects local temperature changes at skin level in patients with tunnelled catheters for haemodialysis and, in the absence of further studies, it may become a helpful tool in the early detection of this type of infection.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-09" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valga F, Monzón T, Henriquez F, Anton-Pérez G. Valoración del orificio de inserción del catéter tunelizado para hemodiálisis mediante el uso de cámara térmica acoplada a <span class="elsevierStyleItalic">smartphone</span>: estudio piloto. Nefrologia. 2020;40:673–674.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1127 "Ancho" => 1500 "Tamanyo" => 240197 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Example of a thermal photograph of the catheter insertion area belonging to one of the patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention and management of catheter-related infection in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.E. 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Roa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PRS.0000000000004126" "Revista" => array:7 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "2018" "volumen" => "141" "numero" => "3" "paginaInicial" => "787" "paginaFinal" => "792" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29481410" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004000000006/v1_202012250708/S2013251420301474/v1_202012250708/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000004000000006/v1_202012250708/S2013251420301474/v1_202012250708/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251420301474?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 74 | 31 | 105 |
| 2024 September | 43 | 34 | 77 |
| 2024 August | 52 | 74 | 126 |
| 2024 July | 45 | 25 | 70 |
| 2024 June | 51 | 33 | 84 |
| 2024 May | 60 | 25 | 85 |
| 2024 April | 49 | 30 | 79 |
| 2024 March | 42 | 24 | 66 |
| 2024 February | 44 | 32 | 76 |
| 2024 January | 27 | 19 | 46 |
| 2023 December | 19 | 27 | 46 |
| 2023 November | 52 | 62 | 114 |
| 2023 October | 59 | 26 | 85 |
| 2023 September | 76 | 26 | 102 |
| 2023 August | 63 | 24 | 87 |
| 2023 July | 67 | 23 | 90 |
| 2023 June | 30 | 22 | 52 |
| 2023 May | 42 | 34 | 76 |
| 2023 April | 39 | 19 | 58 |
| 2023 March | 27 | 16 | 43 |
| 2023 February | 42 | 17 | 59 |
| 2023 January | 44 | 34 | 78 |
| 2022 December | 58 | 42 | 100 |
| 2022 November | 52 | 49 | 101 |
| 2022 October | 60 | 66 | 126 |
| 2022 September | 58 | 33 | 91 |
| 2022 August | 32 | 28 | 60 |
| 2022 July | 40 | 55 | 95 |
| 2022 June | 27 | 32 | 59 |
| 2022 May | 44 | 32 | 76 |
| 2022 April | 46 | 53 | 99 |
| 2022 March | 51 | 55 | 106 |
| 2022 February | 56 | 52 | 108 |
| 2022 January | 49 | 48 | 97 |
| 2021 December | 36 | 41 | 77 |
| 2021 November | 34 | 36 | 70 |
| 2021 October | 84 | 60 | 144 |
| 2021 September | 48 | 42 | 90 |
| 2021 August | 67 | 45 | 112 |
| 2021 July | 44 | 44 | 88 |
| 2021 June | 39 | 32 | 71 |
| 2021 May | 34 | 49 | 83 |
| 2021 April | 63 | 78 | 141 |
| 2021 March | 57 | 49 | 106 |
| 2021 February | 62 | 30 | 92 |
| 2021 January | 60 | 31 | 91 |
| 2020 December | 9 | 7 | 16 |
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