Outcome of tunneled hemodialysis catheters placed via the right internal jugular vein by interventional radiologists.

Abstract

To assess the outcome of interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein. In 194 patients, the catheter was placed via the right internal jugular vein unless thrombosis was present. Real-time ultrasound-guided puncture and fluoroscopic guidance were used. Patients were followed up until catheter removal or death. Outcomes evaluated included infection, thrombosis, and catheter malfunction. In 175 patients, 250 consecutive catheters were placed via the right internal jugular vein with 100% success. All catheters functioned immediately after placement. Procedural complications were limited to clinically unimportant air embolus (n = 2). No instances of pneumothorax, hemothorax, or substantial bleeding complications occurred. Follow-up was available in 173 (99%) patients. Mean and median "catheter duration" were 87 and 56 days, respectively. Catheter-related symptomatic venous thrombosis or stenosis was not observed. The rate of infection was 0.08 per 100 catheter days, and the rate of malfunction that necessitated removal was 0.22 per 100 catheter days. Definite or possible catheter thrombosis that necessitated removal occurred at a rate of 0.16 per 100 catheter days. Interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein showed equal or better long-term results than those reported for surgical placement. Interventional radiologic placement should be the method of choice.