A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein

Abstract

BackgroundRight internal jugular vein (IJV) is a preferred access route for tunneled (cuffed) dialysis catheters (TDCs), and both right external jugular vein (EJV) and left IJV are alternative routes for patients in case the right IJV isn’t available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs.Methods49 hemodialysis patients who required TDCs through right EJV (n = 21) or left IJV (n = 28) as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI).ResultsA total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262–605) catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007). Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031). There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363–3.588; p = 0.001).ConclusionsRight EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.

Numerical Simulation of Hemodynamic Changes in Central Veins after Tunneled Cuffed Central Venous Catheter Placement in Patients under Hemodialysis

“…Although A-V fistula and A-V graft are preferential types of vascular access, tunneled CVC provides an important alternative for hemodialysis patients who have a poor vascular condition or who are waiting for an alternative access to mature 1 , 2 . Over the past 10 years, CVCs have played an increasing role in hemodialysis because they have advantages over arteriovenous access including the relative ease of placement, removal, replacement and the possibility for immediate use 1 – 4 .…”

Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study

“…Previous studies have indicated that the catheter-related bloodstream infection is several times more common than AVF and AVG, and 12-month rate of catheter-related bloodstream infection is approximately 50% among patients who receive HD 26 , 27 , and infection is the second most common cause of hospitalization and death among HD patients 28 , 29 . Furthermore, the incidence of catheter-related infection can reach 0.28–1.7 episodes per 1000 CVC days 30 – 32 . Thus, strategies are needed to reduce the rate of VA-induced infection.…”

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem

“…All patients had a history of prior TCCs insertion, and the reasons for the in-hospital TCC replacement were as follows: catheter dysfunction ( n = 15), long-term duration and regular catheter exchange ( n = 6), symptomatic extremity and/or facial edema ( n = 5), catheter extrusion ( n = 1). TCC dysfunction was defined as an inability to maintain adequate extracorporeal blood flow without prolonging the prescribed HD treatment, inability to flush the locking solution from TCC lines, blood flow rate <300 ml/min, arterial pressure <250 mmHg, high venous pressure >250 mmHg, or the need for TCC lines reversal ( 2 , 16 , 17 ). All the lesions were confirmed through MSCTV.…”