Introduction:
As vascular access sites become progressively thrombosed, alternative anatomical locations must be considered. Here, we describe ten patients who underwent fluoroscopy-assisted, percutaneous placement of tunneled cuffed hemodialysis catheters (TCHC) in the external jugular vein (EJV), with short term follow-up data of duration of catheter patency and occurrence of complications, such as catheter dysfunction or catheter-related bloodstream infection (CRBSI).
Methods:
Between June 2023 and March 2024, we evaluated the data of 10 patients who underwent TCHC placement through the right EJV following right IJV thrombosis. All patients were checked for patency of Superior vena cava. Under Fluoroscopy guidance right EJV cannulation was attempted from lateral side just above clavicle under USG guidance and guidewire was advanced through introducer needle. After confirming the guidewire position, we progressed to subcutaneous tunnel creation and cuffed catheter placement as done for Right IJV TCHC placement. In few cases, where we failed to advance the guidewire, we used hydrophilic guidewire for catheter advancement. Patients were followed up for a minimum period of 6 months for occurrence of complications and duration of catheter patency.
Results:
Technical success was achieved in all patients. All ten TCHCs were inserted into the right EJV . Over the follow-up period, four patients developed CRBSI. Antibiotic treatment successfully salvaged the catheters in three of these patients, while one patient required catheter removal after a second episode of CRBSI at 180 days. Two patients underwent catheter removal at day 90 and 120 respectively, following left arteriovenous fistula maturation. One patient was lost to follow-up. Importantly, no cases of catheter dysfunction or symptomatic venous thrombosis were observed. Currently, six patients continue to undergo hemodialysis through EJV catheters with the longest duration of catheter patency being 300 days
Conclusions:
Most catheters remained functional at 6 months, with no catheter dysfunction. Complications such as CRBSI were successfully managed in most cases. TCHC placement through the right EJV is a viable alternative following right IJV thrombosis and offers the advantage of avoiding the technical challenges and complications associated with left sided TCHC placement and preserving the left IJV for future vascular access.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.