Placement of a Hemodialysis Catheter using the Dilated Right External Jugular Vein as a Primary Route

Abstract

The number of patients with end stage renal disease requiring catheter-based hemodialysis has increased in recent decades. Catheter-based hemodialysis is commonly used during the time it takes for arteriovenous fistula maturation. Conventional venous access sites such as the subclavian vein (SCV) and internal jugular vein (IJV) had been used for catheter placement. However, the SCV should be preserved from catheterization, with consideration of the risk of venous stenosis or thrombosis as complications after a procedure in a patient where fistula or graft creation is planned. The rate of complications for an SCV approach is higher than for an IJV approach. The IJV has become the preferred pri- Results: Technical success was achieved for 41 patients (98%). Catheter placement was unsuccessful in one patient due to narrowing of the EJV. The catheter dwell time ranged between 14 and 305 days (mean; 76 days, total catheter days: 3,111 days). A total of 26 hemodialysis catheters were removed due to complications (n=2) and termination of hemodialysis via the hemodialysis catheter (n=24). There was air embolization (n=1) and catheter kinking (n=3) during procedures and catheter related infections (n=2) during the follow-up period. The incidence of catheter related infection was 0.06 per 100 catheter days. No cases of catheter malfunction or symptomatic venous thrombosis were observed. Conclusion:We suggest that a dilated right EJV could be considered as a preferred primary route for hemodialysis catheter placement with easy access.