Tunneled Dialysis Catheter Insertion in External Jugular Vein by Nephrologists

Abstract

External jugular vein (EJV) is used to insert tunneled dialysis catheter (TDC) in patients with no AVF and exhausted right internal jugular veins (IJV). There is scarce data on TDC insertion in EJV by nephrologists with fluoroscopy guidance. This was a prospective observational study that included hemodialysis patients with exhausted right IJV access who underwent EJV TDC insertion, and excluded occluded ipsilateral brachiocephalic vein or superior vena cava, EJV < 5 mm diameter, or patients with existing EJV TDC. All patients underwent evaluation of central veins. TDC insertions were performed by a nephrologist using ultrasound and fluoroscopic guidance. The primary outcome was the successful insertion of EJV TDC and catheter removal within 6 months due to major catheter dysfunction or complications. EJV TDC was successfully inserted in 23/23 cases (100% success), of which 17 (73.9%) were in right side, and 21 (91.3%) were denovo insertions. Catheter dysfunction needing removal occurred in seven cases (30.4%) with subclavian vein thrombosis in five cases (21.7%) and infectious complications in two cases (8.6%). The censored catheter survival was 23/23 (100%) at 1 month, 22/23 (95.6%) at 3 months, and 13/20 (65%) at 6 months. Cases of EJV catheter removal had a significant association with drainage of EJV into subclavian vein as compared to other anatomical variants (p = 0.005). EJV TDC insertion has a good technical success rate when performed under fluoroscopy. It is associated with an acceptable rate of catheter dysfunction, especially thrombosis, which is more common in EJV opening into subclavian veins.