Hemodialysis as a Risk Factor for Lower Right Internal Jugular Stenosis in Cardiac Surgery Patients: A Retrospective Single-Center Study.

Jae-Woo Ju,Tae Kyong Kim,Youn Joung Cho,Hyo Jun Yang,Karam Nam,Yoomin Oh,Jinyoung Bae,Yunseok Jeon,Seohee Lee

doi:10.3390/jcm10051042

Abstract

Lower right internal jugular vein (RIJ) stenosis has been reported as a common cause of RIJ catheterization failure. However, the risk factors for lower RIJ stenosis in patients undergoing cardiac surgery is unclear. We reviewed the electronic medical records of all adult patients who had undergone cardiac operations in a single tertiary university hospital from January 2014 to January 2016. Patients were excluded if they were lack of preoperative contrast-enhanced chest computed tomography (CT) studies. Lower RIJ stenosis was defined as a ratio of cross-sectional area at the smallest level to cross-sectional area at the largest level less than 25%. Multivariable logistic regression analyses were used to investigate the risk factors for lower RIJ stenosis. A sensitivity analysis was also conducted using a cross-sectional area ratio of under 20%. The analysis included 889 patients, and the incidence of lower RIJ stenosis was 3.9%. The multivariable logistic regression analyses revealed that hemodialysis was an independent risk factor for lower RIJ stenosis (OR, 3.54; 95% CI, 1.472–8.514). Sensitivity analysis provided that hemodialysis (OR, 10.842; 95% CI, 3.589–32.75) was a significant predictor of cross-sectional area ratio <20%. Preoperative hemodialysis are significantly associated with an increased risk of lower RIJ stenosis in patients undergoing cardiac surgery. Extra care is needed during central venous catheterization in hemodialysis patients undergoing cardiac surgery.

Highlights

In cardiac surgery, central venous catheterization (CVC) is mandatory due to the high incidence of blood transfusion, vasoactive drug infusions, and the need for pulmonary artery pressure monitoring
In our multivariable logistic regression analysis, hemodialysis was the only significant independent factor for lower Right internal jugular vein (RIJ) stenosis (odds ratio (OR), 3.54; 95% confidence interval (CI), 1.472–8.514; p = 0.005) (Table 4)
In cardiac surgery patients, and preoperative hemodialysis was significantly associated with an increased risk of lower RIJ stenosis

Summary

Introduction

Central venous catheterization (CVC) is mandatory due to the high incidence of blood transfusion, vasoactive drug infusions, and the need for pulmonary artery pressure monitoring. Right internal jugular vein (RIJ) catheterization is favored over subclavian vein or femoral vein catheterization in cardiac surgery patients because it provides the shortest and straightest path to the heart [1], has a favorable distance from the surgical field [2], and makes it easy to insert a pulmonary artery catheter [3]. It is sometimes necessary to place a central venous catheter on the left internal jugular vein (LIJ) or other central veins due to the unexpected failure of RIJ catheterization in cardiac surgery patients [6]. The incidence of catheter-related complications, such as pneumothorax, catheter malposition, and thoracic duct injury, is lower in RIJ catheterization compared with other sites [4,5].

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