Placement of Tunneled Cuffed Hemodialysis Catheters Via Internal Jugular Vein by an Interventional Radiologist and a Vascular Surgeon Together

Kim, Yang Ho; Lim, Hyung Guhn; Park, Sung Gil; Lim, Ji Hyun; Kim, Young Seok; Lee, Jin Gu; Choi, Sun Pil; Kim, Jung Hwa; Lee, Kwang Young

Abstract

BACKGROUND: The use of dacron-cuffed tunneled double-lumen catheters for hemodialysis has become more common as patients wait for creation and maturation of a permanent access. Placement of the catheters is done by interventional radiologists, vascular surgeons or nephrologists, and the differences in success rates, complications, blood flow rates and the durations of catheter uses are reported. This study evaluated the usefulness, complications, blood flow rates and duration of use of tunneled cuffed hemodialysis catheters implanted via the internal jugular veins by an interventional radiologist and a vascular surgeon together.
METHODS
The outcomes were retrospectively analyzed of 31 hemodialysis catheters placed from December 1999 through January 2001. We investigated age, sex, indications and locations of insertion, catheter performance, complications and causes of catheter removal. All the catheters were placed via the internal jugular veins by an interventional radiologist and a vascular surgeon together.
RESULTS
Catheter placements were successful in all patients. Procedural complication was limited to clinically unimportant minor local bleeding. No instances of pneumothorax, hemothorax, vessel injury, substantial bleeding, obstruction, malposition or stenosis occurred. The blood flow rate on the first hemodialysis after placement of the catheter was 230+/-35.5 mL/min and that after 1 month was 248+/-18.6 mL/min. Late complications included catheter breakage in two cases (6.5%) and bacteremia in four cases (12.9%). Catheters were removed because of catheter-related bacteremia in four cases (12.9%) and death of patients in three cases (9.7%). In 22 cases (71.0%) the catheters were removed because the A- V vascular accesses were available for hemodialysis. Mean duration of the catheter use before removal was 134+/-96 days.
CONCLUSION
Tunneled cuffed catheters inserted via the internal jugular veins are safe and durable vascular accesses for hemodialysis with good blood flow rate and long duration of use, especially placed by the co-operation of an interventional radiologist and a vascular surgeon.