Long-Term Tunneled Hemodialysis Catheters: Achieving Efficiency Through Tip Position Optimization

Abstract

This retrospective study assesses the influence of tunneled hemodialysis catheter tip location and lateralization on catheter-related complications, including dysfunction and catheter-related bloodstream infection. Using data from 162 patients who underwent catheter placement between January 2017 and December 2020, postoperative chest X-rays and clinical records were reviewed. Outcomes were assessed based on catheter removal duration and complication incidence. Out of 177 catheter placements, 56 (32%) patients experienced complications during an average 530-day follow-up. Catheters placed in the superior vena cava (SVC) exhibited more severe complications with shorter dwell times compared with those in the pericavoatrial junction (pCAJ) or right atrium (RA). Moreover, complication rates were significantly higher (P<0.01) in the SVC (1.91 per 1000 catheter days) compared with the pCAJ (0.54) or RA (0.47). Lateralization (right or left internal jugular vein) did not significantly affect the complication rates (0.60 vs. 0.58; P=0.90). However, in subgroup analysis, a significantly higher complication rate was observed for catheters with tips inserted from the left side into the SVC than for those inserted from the right side (6.6 vs. 1.5; P<0.01). Catheters with tips in the SVC exhibited more severe complications than those in the pCAJ or RA, with left-side insertion of SVC-tipped catheters resulting in significantly higher complication rates compared with right-side insertion. These findings highlight the importance of optimal catheter tip positioning in long-term hemodialysis care to minimize complications and enhance patient outcomes.