Introduction:
Right internal jugular vein (RIJV) is the commonest site for tunneled dialysis catheter (TDC). After exhaustion of RIJV, left internal jugular vein (LIJV), right external jugular vein (REJV), or other veins, may be used. This prospective study compared the clinical profile and outcomes of TDC in REJV vs LIJV.
Methods:
A prospective non-randomized single centre study included ESRD patients on with TDC, with exhausted RIJV while patients with SVC occlusion were excluded. Patients with patent REJV/ right BCV underwent REJV TDC. Patients with occluded REJV/ right BCV underwent LIJV TDC. Primary outcome was cumulative catheter patency (insertion to removal of TDC), while secondary outcomes was primary catheter patency (insertion to TDC catheter dysfunction) and CRBSI. Appropriate IEC approval and patient consent was obtained. Patients were followed up for minimum 1 year.
Results:
Fifty patients were included from Jan 2020 to Dec 2023. All TDC insertions were done under USG or fluoroscopic guidance, using symmetrical tip catheter (Palindrome, Covidien), using standard protocols. TDC insertions were 23 (46%) in REJV and 27 (54%) LIJV arm, with mean age 48.6±4.5 years, 28 (56%) males, 24 (48%) diabetes; mean duration of RIJV 178.6±34.5 days (similar in both groups). Primary outcome of catheter removal occurred in 10 (37%) in LIJV arm and in 04 (17.3%) in REJV arm (HR 0.67, 95% CI: 0.62-0.97, p=0.008); while cumulative patency was 262.6±39.5 days in LIJV arm and 335.6±49.5 days in REJV arm (p=0.04). Amongst LIJV and REJV, catheter dysfunction was seen in 14(51.8%) and 6(26%) (HR 0.79, 95% CI: 0.72-1.32, p=0.02); while CRBSI was seen in 7(25.9%) and 4(17.3%) (HR 0.92, 95% CI: 0.42-1.44, p=0.3). Cox proportional hazards model studied factors predisposing cumulative catheter patency - duration of previous catheter (HR 2.24, 95% CI: 1.42-3.72, p=0.02) and central vein thrombosis (HR 1.89, 95% CI: 1.33-4.32, p=0.04), were statistically significant.
Conclusions:
Right EJV access is superior to left IJV as an alternate insertion route for TDC in patients on hemodialysis with exhausted RIJV.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.