A Retrospective Study Of Preferable Route For Placing Tunneled Dialysis Catheters:Right External Jugular Vein Versus Left Internal Jugular Vein

Background and ObjectiveVascular access is a major issue in chronic hemodialysis patients. Arteriovenous fistula(AVF) is recommended to be the first choice, while tunneled dialysis catheter(TDC) may provide a temporary or permanent access for HD patients who wait for AVF maturing, or have malfunctioned AVFs. It has been recommended by the K/DOQI guidelines that right internal jugular vein(IJV) is a preferred insertion site for hemodialysis(HD) catheters, and both right external jugular vein(EJV) and left internal jugular vein(IJV) are alternative sites for those who have encountered severe thrombosis and/or occlusion of right IJV. This retrospective study aimed to determine if superiority exists between the two alternative sites by comparing the outcomes of tunneled dialysis catheter(TDC) through right EJVs versus left IJVs in HD patients who had failed right IJV. MethodsFrom January 1, 2013 to December 31, 2014, 49 hemodialysis patients who required TDC through right EJV(n = 21) or left IJV(n = 28) as long-term vascular access were included in this study, and the patients' follow-up time was to March 31, 2015. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections(CRBSI). Using SPSS 22.0 software, baseline patient characteristics were compared by independent t test or Wilcoxon rank sum test for quantitative variables, and chi-square test for categorical variables. Kaplan-Meier method was used to observe primary and secondary catheter patency, and multivariate Cox proportional hazards regression analysis were conducted to find out the independent factors of catheter events. A p-value of <0.05 was considered statistically significant. ResultsA total of 20,870 catheter-days were evaluated and the median was 384(interquartile range, 262–605) catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group(P = 0.007). Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group(P = 0.031). There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212(95% CI, 1.363–3.588; P =0.001). ConclusionRight EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.