Dialysis Catheter Research Articles

Flow problems during implantation of a peritoneal dialysis catheter: building a capnoperitoneum using the peritoneal dialysis catheter

Flow problems during implantation of a peritoneal dialysis catheter: building a capnoperitoneum using the peritoneal dialysis catheter

Risk Factors associated with Central Vein Stenosis Development in Hemodialysis Vascular Access among Patients with Normal Preoperative Venography

We aimed to discover risk factors for central vein stenosis (CVS) in hemodialysis patients with normal preoperative venography. Among the 411 individuals who underwent upper arm venography for hemodialysis access evaluation in 2017, we reviewed venography and medical record data from 349 patients with normal preoperative venography who subsequently underwent arteriovenous fistula creation. We compared the data between patients with and without CVS development. Among the 349 patients, 22 (6.3%) developed CVS during a median 20.9-month follow-up. The development of CVS appeared to be associated with preoperative venography findings (the presence of collateral vessels and cephalic arch stenosis), location of hemodialysis access, and history and duration of ipsilateral hemodialysis catheter placement (p < 0.05). Multivariate analysis identified two or more collateral vessels on venography, left-sided arteriovenous fistula, and a previous history of ipsilateral hemodialysis catheter placement as independent risk factors for CVS development (p < 0.05). Even in patients with normal preoperative venography findings, there is an increased possibility of CVS development after arteriovenous fistula creation if they have more than two collateral vessels on venography, a left-sided arteriovenous fistula, or a history of ipsilateral hemodialysis catheter placement.

Durability of non-tunneled hemodialysis catheter in stage 5 chronic kidney disease not associated with diabetes mellitus. A single study at Dr Soetomo General Hospital

Durability of non-tunneled hemodialysis catheter in stage 5 chronic kidney disease not associated with diabetes mellitus. A single study at Dr Soetomo General Hospital

Salvaging intraluminal peritoneal dialysis catheter obstruction from blood clot with a targeted thrombolytic agent: an innovation.

Peritoneal dialysis (PD) catheter malfunction commonly leads to the removal of the catheter and eventually to a transfer to hemodialysis. The most common cause is intraluminal obstruction caused by blood and fibrin clots. Recommended interventions include irrigation of the catheter with heparinized saline; if this method fails, thrombolytic agents may be used. Mechanical methods such as intraluminal brushing are also utilized, typically after medical treatment fails. Here, we present a case of a patient who developed an intraluminal blood clot that persisted despite attempts with intraluminal thrombolytic drugs and intraluminal brushing. To salvage the catheter, targeted thrombolysis was performed using an endoscopic retrograde cholangiopancreatography (ERCP) guidewire to reinforce the coiled PD catheter and puncture the clots. Additionally, a Swing Tip cannula was employed for direct injection of the thrombolytic agent. These interventions successfully preserved the catheter, resolving the clot and ensuring continued functionality.

Non-tunneled haemodialysis catheter-related blood stream infections and associated factors among first time haemodialysis patients: a prospective study from a tertiary care hospital in Sri Lanka

BackgroundA significant number of patients require non-tunneled haemodialysis catheters (NTHCs) in the event of an urgent need for immediate haemodialysis in developing countries. Catheter-related bloodstream infections (CRBSIs) are a major concern in haemodialysis, but there is a lack of local epidemiological data. This study aimed to determine the incidence of CRBSI, causative agents and associated risk factors in a tertiary care hospital in Sri Lanka.MethodsA prospective study was conducted at the dialysis unit of Colombo South Teaching Hospital, Sri Lanka from December 2019 to August 2020. Adult patients who had haemodialysis for the first time with NTHCs were included.ResultsOf 149 dialysis patients (104—jugular vein and 45—femoral vein, mean age 58 ± 13.7 years, mean duration of catheterization 7.9 ± 3.4 days), the incidence of CRBSI was 13.58 per 1000 catheter days. Serum albumin levels, capillary blood sugar levels at admission, haemoglobin levels and duration of catheterization were significantly associated with CRBSI. Prescence of diabetes and patients with ESRD who started routine haemodialysis had a significantly higher risk of CRBSI. Gram-positive bacteria were the most common microorganisms associated with CRBSI (87.5%).ConclusionsOur results show high rates of infection with temporary vascular catheters in Sri Lanka, mainly due to Gram-positive bacteria. Diabetes mellitus, duration of catheterisation, low serum albumin, haemoglobin level and CBS on admission were identified as significant risk factors for CRBSI. Management strategies tailored to specific centers should be established in the nation to optimise catheter care and to monitor local microbiology for appropriate empirical antimicrobial treatment.

A Review of Central Vein Catheter for Hemodialysis: Insertion Sites and Techniques

Chronic kidney disease (CKD) is a global epidemic, being increasingly prevalent in both developed and developing countries, including Indonesia. Hemodialysis (HD) is the primary renal replacement therapy, along with peritoneal dialysis and kidney transplantation. The effectiveness of HD relies on well-functioning vascular access, such as central vein catheters (CVCs). These catheters are classified by their duration of use: short-term, medium-term, and long-term. They are also distinguished by insertion type (central or peripheral), insertion site (jugular, subclavian, femoral), and number of lumens (single, double, triple). The preferred site for insertion is the internal jugular vein, followed by the femoral vein and the subclavian vein. Techniques for CVC insertion include the central approach, the posterior approach, and others. This article reviews the role of CVC for vascular access in HD. Specifically, various CVC insertion sites and techniques will be examined. The authors will also discuss the available research on the application of CVC as vascular access for HD in Indonesia.

A Dedicated Nephrology Daycare Unit: A Step Toward a Patient-Centered Approach.

Background Nephrology services encompass a wide range of day-care procedures. Securing beds for day admissions can be challenging and may lead to significant delays in patient management. Objective This study aims to describe the impact of establishing a dedicated nephrology daycare unit at a tertiary care center. Methods Since January 2021, a dedicated nephrology daycare unit has been operational at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. This observational study retrospectively reviewed the admission records to the KAUH nephrology daycare unit from January 2021 to December 2023. Admissions with missing data were excluded from the analysis. The study outcomes included: 1. the number of patients served in the unit, 2. the scope of services provided, 3. the "time to completion" of immunosuppressive therapy administered in the unit, and 4. the rate of complications related to admission to the unit. Results There were 233 admissions for 157 patients. The scope of procedures included: 1. administration of immunosuppressive therapy (42 doses of cyclophosphamide, 70 doses of rituximab, three doses of methylprednisolone), 2. renal biopsies (25 procedures), 3. tunneled dialysis catheter procedures (40 procedures, both insertion and removal), 4. dialysis access angioplasty (three procedures), 5. IV iron therapy (45 admissions), and 6. other miscellaneous causes (five admissions). Ideal time to completion of cyclophosphamide therapy was achieved in 86% of patients, with the remaining 14% experiencing delays due to reasons other than bed availability. Time to completion of rituximab therapy was achieved without delay in 85% of patients, with a time interval of less than 21 days. There were no reported complications associated with admission to the unit. Conclusions Establishing a dedicated nephrology daycare unit facilitates the delivery of nephrology day-procedures and reduces delays in therapy.

Placement of tunneled hemodialysis catheters - interventional standard.

While the native arterio-venous fistula (AVF) remains the first choice in vascular access for most hemodialysis patients, tunneled hemodialysis catheters (tHDC) continue to be an option in selected patients. Since timely access to vascular surgery-due to delayed referral or resource limitations-is not always possible, nephrologists have to become more actively involved in planning, creation and monitoring of vascular access. Moreover, this approach could also strengthen patient-centered care in nephrology. This manuscript reviews the current standard in tHDC creation, patient selection and strategies to mitigate the risk of infectious complications and catheter thrombosis. Presentation of novel developments in catheter placement with ultrasound-guided or ECG-guided positioning, their benefits and possible disadvantages emphasizes the complexity of vascular access planning. We offer an approach for choice of insertion method, depending on selected side and existing resources and set focus on the necessity and required resources of 'interventional nephrology' training programs.

Comparing the Hemodynamic Effects of Intravenous and Volatile Anesthesia in Patients with End Stage Renal Disease Undergoing Laparoscopic Implantation of Peritoneal Dialysis Catheter in a Randomized Double-Blind Clinical Trial

Background: Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach. Methods: 72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12. Results: There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P&gt;0.05), although DBP fluctuation&gt;20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively). Conclusion: The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

Interventional nephrology in peritoneal dialysis: Best practice report of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology.

The procedure of peritoneal dialysis (PD) catheter placement is of utmost importance for a good outcome of peritoneal dialysis. Currently, catheters are mainly placed by surgeons and interventional nephrologists. Still, there is a lack of trained personnel in many dialysis units, which can impair the efficiency of PD units and reduce the patients' possibility to enter a PD programme. The Italian Society of Nephrology has endorsed a practical core curriculum for interventional nephrology in PD available on the Society website, which is here reported for the wider nephrology community. The topics addressed are the hernias of the abdominal wall, catheter placement with standard surgical open technique, basic video-laparoscopy, advanced video-laparoscopy, video-laparoscopic cholecystectomy and catheter placement, cuff-shaving and video-laparoscopy in catheter malfunction.

Impact of a 'Catheter Bundle' on Infection Rates and Economic Costs in the Intensive Care Unit: A Retrospective Cohort Study.

Catheter-related infections (CBRSIs) are a widespread problem that increase morbidity and mortality in intensive care unit (ICU) patients and management costs. The main aim of this study was to assess the prevalence of CBRSIs in an intensive care unit following international literature guidelines for managing vascular lines in critically ill patients. These guidelines include changing vascular lines every 7 days, using needle-free devices and port protectors, standardising closed infusion lines, employing chlorhexidine-impregnated dressings, and utilising sutureless devices for catheter securement. This single-centre retrospective observational study was conducted in a general Italian ICU. This study included all eligible patients aged > 1 year who were admitted between January 2018 and December 2022. During the study period, 1240 patients were enrolled, of whom 9 were diagnosed with a CRBSI. The infection rate per 1000 catheters/day was as follows: femorally inserted central catheter, 1.04; centrally inserted central catheter, 0.77; pulmonary arterial catheter 0.71, arterial catheter, 0.1; and peripherally inserted central catheter and continuous veno-venous haemodialysis dialysis catheters equal to 0. No difference in CRBSI was observed between the years included in the study (p = 0.874). The multivariate analysis showed an association between the diagnosis of CBRSI and Nursing Activities Score (per single point increase β = 0.04-95%CI: -0.01-0.09, p = 0.048), reason for ICU admission-trauma (β = 0.77-95%CI: -0.03-1.49, p = 0.039), and use of therapeutic hypothermia (β = 2.06, 95%CI: 0.51-3.20, p < 0.001). Implementing the study protocol revealed a cost of EUR 130.00/patient, equivalent to a daily cost of EUR 15.20 per patient. This study highlights the importance of implementing a catheter care bundle to minimise the risk of CRBSI and the associated costs in the ICU setting. A policy change for infusion set replacement every 7 days has helped to maintain the CRBSI rate below the recommended rate, resulting in significant cost reduction and reduced production of ICU waste.

AN EXPERIMENTAL RIGHT ATRIUM PLATFORM TO ASSESS RECIRCULATION IN HEMODIALYSIS CATHETERS

Hemodialysis (HD) is a treatment supporting decreased kidney function, via a catheter inserted into the heart’s Right Atrium (RA). Recirculation is a source of inefficiency for treatment, where blood is dialyzed again due to poor catheter design. Lab-testing is still relatively unexplored, hence, a mechanical testing system was designed with the intention of providing a consistent and repeatable environment for testing HD catheters. System geometry was composed using a Computer-Aided Design (CAD) model of a heart, with the RA scaled to appropriate dimensions, and a PolyDiMethylSiloxane (PDMS) model produced through 3D printing and negative wax casting. Pulsatile blood flow was mimicked by peristaltic pumps driving a blood analogue (BA). Recirculation was induced by adding dyed BA to the system via the catheter and measured using a colorimeter. The developed platform was initially evaluated using two catheters, demonstrating the capability to accurately replicate atrial hemodynamic conditions. Two step-tipped catheters, A and B, were tested at 350 ml/min, producing recirculation values of 13.11% and 18.58%, respectively. The results exhibit the ability of the system developed to evaluate HD catheter performance, with the potential to explore a wider range of tip geometries relevant to clinical preference. Furthermore, this advancement towards an anatomically accurate lab-based test system could be paired with computational methods to progress the evaluation of such medical devices and enhance their development.

Epidemiology and Clinical Features of Burkholderia Bacteremia at a Hospital in India.

Burkholderia spp. are opportunistic pathogens that cause infection in patients with disrupted immunity. The study intended to demonstrate the epidemiology and clinical features associated with Burkholderia spp. bacteremia. This retrospective study was performed to assess the clinical and laboratory characteristics of patients whose blood cultures were growing Burkholderia spp. and, based on their underlying comorbidities, were subjected to survival analysis from January 2022 to December 2022 at a university hospital in northern India. Three hundred patients with Burkholderia spp. bacteremia were included in this study conducted over 1 year. The mean age of the patients was 33.86 years with a male predominance of 56.67% (170/300, 56.67%). Underlying malignancies (207/300, 69.0%) were the most common clinical diagnosis, and catheter in situ (300/300, 100.0%) was the most common risk factor. Burkholderia cenocepacia (244/300, 81.33%) was the most common Burkholderia spp. isolated. All isolates were highly susceptible to minocycline. Kidney disease (P = 0.029), hypertension (P = 0.005), type 2 diabetes mellitus (P = 0.039), and respiratory disease (P <0.001) in patients were significantly associated with death owing to Burkholderia spp. bacteremia, whereas patients with malignancies (P <0.001) and undergoing treatment were significantly associated with a better outcome when the microorganism was susceptible to empirical antibiotics. The presence of indwelling devices, mechanical ventilation (P <0.001), and a hemodialysis catheter (P = 0.026) were statistically significant risk factors associated with poor outcomes.

An abysmal conundrum associated with a misplaced dialysis catheter.

A 25-year-old female patient with chronic glomerulonephritis, initiated on haemodialysis presented with high-grade fever, a dysfunctional catheter, low oxygen saturation and unstable blood pressure. Upon evaluation, the patient was febrile with elevated white blood cell counts. She was intubated, started on inotropes and transferred to the intensive care unit. Chest radiography showed that the tunnelled internal jugular dialysis catheter had migrated to the inferior vena cava. Echocardiography and transoesophageal echocardiography showed severe heart dysfunction with a large thrombus attached to the catheter, indicating catheter-related atrial thrombus (CRAT). CT pulmonary angiography revealed blockage of the segmental pulmonary arteries, suggesting pulmonary embolism. Blood and tracheal cultures revealed Methicillin-resistant Staphylococcus aureus (MRSA). The patient was administered appropriate antibiotics and anticoagulants and underwent surgical removal of the thrombus and the catheter. This case demonstrates the risks associated with improper placement of dialysis catheters and highlights the brief management of CRAT.

Incidence of fatal and non-fatal pulmonary thromboembolism after removal of tunnelled central venous haemodialysis catheters without ultrasound scan and anticoagulation.

Catheter related thrombosis is a common complication of tunnelled central venous catheter (TCVC) usage. There are concerns that TCVC removal could dislodge a thrombus to cause pulmonary thromboembolism (PE). The incidence of PE following TCVC removal is unclear and so the aim of this study was to investigate the incidence of PE and whether it is high enough to warrant screening with ultrasound with a view to systemic anticoagulation prior to TCVC removal. 1102 consecutive TCVC removals without ultrasound and systemic anticoagulation were included in this retrospective study. Data were extracted from electronic health records. Measures to identify PE events included: deaths, computed tomography pulmonary angiogram (CT-PA), isotope lung perfusion scans and D-dimers blood tests within 7 days of removal. Of the 1102 TCVC removals, the mean age of patients was 56.9 years and 57.3% were male. The primary renal diagnosis for 24.5% of patients was diabetic nephropathy. There were seven deaths following removal, none of which had PE as a contributing cause on review of their clinical history and death certificates. Five CT-PAs and one isotope lung perfusion scan were carried out in the 7 days after TCVC removal and none had a positive finding of PE. Three patient had D-dimers measured in blood within 7 days and none of these patients were subsequently diagnosed with PE. There was no evidence of fatal or non-fatal PE's occurring in the 7 days following TCVC removal. This would support the practice of removing TCVCs without the need for ultrasound screening and without a period of systemic anticoagulation.

PRO-READ IR: Enhanced PROcedural Information READability for Patient-Centered Care in Interventional Radiology With Large Language Models

PurposeTo evaluate the extent to which Generative Pre-trained Transformer 4 (GPT-4) can educate patients by generating easily understandable information about the most common interventional radiology (IR) procedures. Materials and methodsWe reviewed 10 IR procedures and prepared prompts for GPT-4 to provide patient educational instructions about each procedure in layman’s terms. The instructions were then evaluated by four clinical physicians and nine nonclinical assessors to determine their clinical appropriateness, understandability, and clarity using a survey. A grade-level readability assessment was performed using validated metrics to evaluate accessibility to a wide patient population. The same procedures were also evaluated from the patient instructions available at radiologyinfo.org and compared with GPT-generated instructions utilizing a paired t test. ResultsEvaluation by four clinical physicians shows that nine GPT-generated instructions were fully appropriate, whereas arterial embolization instructions was somewhat appropriate. Evaluation by nine nonclinical assessors shows that paracentesis, dialysis catheter placement, thrombectomy, ultrasound-guided biopsy, and nephrostomy-tube instructions were rated excellent by 57% and good by 43%. The arterial embolization and biliary-drain instructions were rated excellent by 28.6% and good by 71.4%. In contrast, thoracentesis, port placement, and CT-guided biopsy instructions received 43% excellent, 43% good, and 14% fair. The readability assessment across all procedural instructions showed a better Flesch-Kincaid mean grade of GPT-4 instructions compared with radiologyinfo.org (7.8 ± 0.87 versus 9.6 ± 0.83; P = .007) indicating excellent readability at 7th- to 8th-grade level compared with 9th to 10th grade. Additionally there was a lower Gunning Fog mean index (10.4 ± 1.2 versus 12.7 ± 0.93; P = .006), and higher Flesch Reading Ease mean score (69.4 ± 4.8 versus 51.3±3.9; P = .0001) indicating better readability. ConclusionIR procedural instructions generated by GPT-4 can aid in improving health literacy and patient-centered care in IR by generating easily understandable explanations.

Superior vena cava thrombosis induced by chemotherapy port: About a case

Superior vena cava syndrome is secondary to obstruction of the superior vena cava and/or brachiocephalic venous trunk, which are currently common during venous catheterization (implantable chamber, dialysis catheter or during placement of an endocavitary stimulation lead). We report the case of a 50-year-old patient with beta thalassemia who had been wearing a chemotherapy box for 2 years, and presented with clinically symptomatic superior vena cava syndrome. A phleboscanner was ordered, showing a tight stenosis of the superior vena cava. A double-approach angioplasty was performed with good postoperative results.

Guidewire entrapment in the Chiari network during the insertion of a hemodialysis catheter: a case report

BackgroundThe Chiari network, a remnant of fetal anatomy, consists of a mesh-like structure within the right atrium. With advancements in cardiac interventions, complications associated with the Chiari network have increasingly been reported. However, there are few reports about guidewire or catheter entrapment in the Chiari network during the insertion of a dialysis catheter.Case presentationA 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network.ConclusionsThis case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.

Comparison of feasibility and effectiveness of tunneled dialysis catheter placement with or without DSA guidance: a propensity score-matched cohort study

Background In some resource-limited regions, the placement of tunneled dialysis catheters (TDC) is often preferred under ultrasound guidance rather than fluoroscopy. This study compared ultrasound-and digital subtraction angiography-guided (DSA)-guided TDC in renal replacement therapy. Methods This retrospective cohort study included all TDC placements performed at our hospital between January 2020 and October 2022. We utilized 1:1 propensity score matching (PSM) to balance the demographic and clinical characteristics of the DSA-guided and ultrasound-guided groups. Dialysis prescriptions and actual dialysis completion were assessed using intraclass correlation coefficients (ICC). Multivariable logistic regression analyses determined the risk factors for early termination of dialysis. The differences in adverse events, catheter function, and catheter tip position were evaluated between the two groups. Results The study included 261 patients (142 in the DSA-guided group and 119 in the ultrasound-guided group). After PSM, 91 patients were included in each group, with no significant baseline differences (p > .1). Both groups achieved adequate catheter blood flow and ultrafiltration volumes without deviations from dialysis prescriptions (ICC ≥ 0.75). The DSA-guided group had fewer early dialysis terminations than the ultrasound-guided group (3.3 vs. 12.0%, p = .026). The position of the catheter tip in the right atrium was more consistent in the DSA-guided group (100 vs. 74.2%, p < .001). Conclusion Hemodialysis catheters inserted under DSA guidance exhibited superior performance compared to those inserted under ultrasound guidance, primarily due to more accurate catheter tip positioning. DSA guidance is recommended when ensuring optimal catheter tip placement.

Tunneled Dialysis Catheter Insertion in External Jugular Vein by Nephrologists

Background External jugular vein (EJV) is used to insert tunneled dialysis catheter (TDC) in patients with no AVF and exhausted right internal jugular veins (IJV). There is scarce data on TDC insertion in EJV by nephrologists with fluoroscopy guidance. Materials and Methods This was a prospective observational study that included hemodialysis patients with exhausted right IJV access who underwent EJV TDC insertion, and excluded occluded ipsilateral brachiocephalic vein or superior vena cava, EJV &lt; 5 mm diameter, or patients with existing EJV TDC. All patients underwent evaluation of central veins. TDC insertions were performed by a nephrologist using ultrasound and fluoroscopic guidance. The primary outcome was the successful insertion of EJV TDC and catheter removal within 6 months due to major catheter dysfunction or complications. Results EJV TDC was successfully inserted in 23/23 cases (100% success), of which 17 (73.9%) were in right side, and 21 (91.3%) were denovo insertions. Catheter dysfunction needing removal occurred in seven cases (30.4%) with subclavian vein thrombosis in five cases (21.7%) and infectious complications in two cases (8.6%). The censored catheter survival was 23/23 (100%) at 1 month, 22/23 (95.6%) at 3 months, and 13/20 (65%) at 6 months. Cases of EJV catheter removal had a significant association with drainage of EJV into subclavian vein as compared to other anatomical variants (p = 0.005). Conclusion EJV TDC insertion has a good technical success rate when performed under fluoroscopy. It is associated with an acceptable rate of catheter dysfunction, especially thrombosis, which is more common in EJV opening into subclavian veins.