Long-term outcome of posterior approach insertion of tunneled cuffed catheter: A single clinic retrospective analysis

Abstract

Background and objectives: For patients who rely on a tunneled cuffed catheter, the internal jugular vein is the preferred site of insertion. A few studies have suggested that the posterior approach for central lines is equivalent or better in comparison to the conventional central approach. However, there have been fewer studies examining tunneled cuffed catheter insertion using the posterior approach. We have performed many posterior insertions of tunneled cuffed catheters in our practice, and because the technique has not yet been comprehensively studied for long-term use, we performed a retrospective study to evaluate the safety and efficacy of posterior approach for tunneled cuffed catheter in maintained hemodialysis patients. Methods: A retrospective review was conducted of 200 hemodialysis patients who were treated with tunneled cuffed catheters over a period of 3 years. There were 104 patients in the study group, as well as a 96-patient control group, who underwent catheter insertion by central approach. The clinical follow-up data were collected and analyzed. Results: All catheters were successfully placed. The mean primary patency days per catheter were 712 catheter days for the study group and 585 catheter days for the control group. The episode of catheter infection was similar in both groups (p = 0.874), but the case of total catheter dysfunction was significantly lower in the study group compared to the control group (p = 0.006). The cumulative patency of catheters was higher in the study group than that in the control group (p = 0.02), while patient survival was the same in the two groups (p = 0.325). Conclusion: The posterior approach is safe, and similar infection rates were observed with lower dysfunction rates compared to tunneled catheter insertion by the conventional central approach.

Low Posterior Internal Jugular Vein Approach for Tunnelled Haemodialysis Catheter Insertion: A Report on Outcomes at a Single Centre

“…This hypothesis is supported by the only comparative data on the subject; a recent single-centre uncontrolled study of 200 patients showed dysfunction-related TDC failure rates of 17% vs 31% for posterior and classic central IJ access respectively. 19 The incidence of catheter-related bacteraemia in our cohort was .39 episodes per 1000 catheter-days. Historically, catheter-related bacteraemia rates of 1.1-5.5 episodes per 1000 catheter-days were reported.…”

“…This hypothesis is supported by the only comparative data on the subject; a recent single-centre uncontrolled study of 200 patients showed dysfunction-related TDC failure rates of 17% vs 31% for posterior and classic central IJ access respectively. 19…”

Clinical application of ultrasound-guided totally implantable venous access ports implantation via the posterior approach of the internal jugular vein

“…Only a relatively few studies using ultrasound-guided central vena catheterization (CVC) for hemodialysis via the posterior approach of the IJV have been reported previously. 10,11 The results suggest that the posterior approach for central lines is equivalent to, or better than, the conventional middle approach. There are some advantages to the posterior approach: first, the IJV usually lies central to the common carotid artery (CA), and thus, the artery lies medially to the IJV when the vein is punctured, which decreases the chance of puncturing the artery when compared to the middle approach; second, the catheter can gradually be inserted into the vein from a lateral direction, which results in a straighter course for tunneling; thirdly, the posterior approach does not cross the SCM muscle and consequently there is less pain and discomfort during and after the procedure.…”

“…There are some advantages to the posterior approach: first, the IJV usually lies central to the common carotid artery (CA), and thus, the artery lies medially to the IJV when the vein is punctured, which decreases the chance of puncturing the artery when compared to the middle approach; second, the catheter can gradually be inserted into the vein from a lateral direction, which results in a straighter course for tunneling; thirdly, the posterior approach does not cross the SCM muscle and consequently there is less pain and discomfort during and after the procedure. 11 However, the posterior approach of the IJV has been rarely reported for TIVAPs, and it is still overlooked.…”