J Korean Soc Radiol.  2011 Dec;65(6):555-562. 10.3348/jksr.2011.65.6.555.

Factors Affecting Longevity of Tunneled Central Venous Catheters

• Park J
• Lee J

• KMID: 2002921
• DOI: http://doi.org/10.3348/jksr.2011.65.6.555

Abstract

PURPOSE
To evaluate factors which affect the longevity of tunneled central venous catheters (T-CVCs).
MATERIALS AND METHODS
A retrospective study was conducted on 363 T-CVCs. We evaluated the relevant factors affecting the longevity of the T-CVCs, such as age, gender, indication for catheterization, site of entry vessel, diameter and type of T-CVC, catheter tip position, and underlying diseases.
RESULTS
Of the 363 T-CVCs which had been inserted, 331 (91%) were placed through the right internal jugular vein (RIJV). The catheter tip position was the strongest predictor for the longevity of the T-CVC. The short limb of the catheter tip placed either at the cavoatrial junction (CA junction) or below the lower margin of the right main bronchus had a good prognosis. The vessel through which the T-CVC was placed significantly influenced the longevity of the T-CVC; the RIJV was associated with better results than the left internal jugular vein. Also, a split-type catheter was significantly associated with a better result.
CONCLUSION
A two distinct and separate type T-CVC placed through the RIJV in which the short limb catheter tip position was at the level of the CA junction, significantly increased the longevity of T-CVCs.

MeSH Terms

Bronchi
Catheterization
Catheters
Central Venous Catheters
Extremities
Glycosaminoglycans
Jugular Veins
Longevity
Prognosis
Renal Dialysis
Retrospective Studies
Glycosaminoglycans

Figure

• 

  Fig. 1 Stratification of the catheter tip position based on cavoatrial junction (CAJ) and right main bronchus (RMB). A. First, during the procedure, the upper (arrows) and lower margins (arrowheads) of RMB are depicted under fluoroscopic guidance. Subsequently the catheter is located with a shorter limb above the upper margin of RMB and a longer limb below lower margin of RMB B. After initial placement of the catheter along the RMB level, transcatheter angiography is performed through each catheter hub by manual injection of 10 mL of 1 : 1 iodinated contrast medium and normal saline solution. By checking the sequential opacification of superior vena cava, right atrium, right ventricle, and pulmonary artery, the tip position is adjusted based on CAJ (arrow).

• 

  Fig. 2 Kaplan-Meier survival curve analysis about the longevity of tunneled central venous catheters (T-CVCs) by the influence of statistically significant covariates. A. The short limb level of T-CVCs at cavoatrial junction (CAJ) shows the best longevity followed by the levels below and above the CAJ. At = at the CAJ, Below = below the CAJ, Above = above the CAJ B. T-CVCs inserted through right internal jugular vein (IJC) shows better longevity than left IJC. RIJV = right internal jugular vein, LIJV = left internal jugular vein C. The short limb level of T-CVCs below the level of right main bronchus (RMB) shadow shows the better longevity than midlevel and above levels. Below = below the lower margin of RMB, Above = above the upper margin of RMB, Mid = between upper and lower margin of RMB D. Split type T-CVCs shows better patency than non-split type. Split = two distinct lumens and separated type, None = two distinct lumens and non-separated type

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