Yaxley Julian, Gately Ryan, Scott Tahira, Kurtkoti Jagadeesh, Mantha Murty
Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia.
Nephrology and Transplant Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Intern Med J. 2024 Apr;54(4):632-638. doi: 10.1111/imj.16200. Epub 2023 Aug 18.
The right internal jugular vein is the preferred approach to tunnelled haemodialysis catheter placement. However, the effect of the insertion site on long-term catheter outcomes remains uncertain.
We aimed to analyse a large cohort of tunnelled haemodialysis catheter placements to compare short-term and long-term results according to central venous catheter location.
A retrospective cohort study was performed on consecutive tunnelled catheter insertions at two centres over 7 years. The primary outcome was catheter survival, compared according to the central vein site. We used the Kaplan-Meier curve method and Cox proportional hazards modelling to determine the effect of the catheterisation route on primary patency, adjusted for clinical risk factors for catheter failure.
There were 967 tunnelled dialysis catheter placements in 620 patients. The median survival for right internal jugular vein catheters was 569 days. There were no differences in rates of catheter failure between right internal jugular, left internal jugular (adjusted hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.52-1.21), external jugular (HR, 0.79; CI, 0.33-3.13), subclavian (HR, 0.67; CI, 0.58-2.44) and femoral vein (HR, 1.20; CI, 0.36-1.33) catheters following multivariable analysis. There were no major differences in functionality or complications between the groups.
This study identified no statistically significant relationship between tunnelled haemodialysis catheter insertion site and catheter survival. The contemporary approach to dialysis vascular access should be tailored to specific patient circumstances.
右侧颈内静脉是置入带隧道的血液透析导管的首选途径。然而，插入部位对导管长期使用结果的影响仍不确定。
我们旨在分析一大群带隧道的血液透析导管置入情况，以根据中心静脉导管位置比较短期和长期结果。
对两个中心7年间连续进行的带隧道导管插入术进行回顾性队列研究。主要结局是导管存活情况，根据中心静脉部位进行比较。我们使用Kaplan-Meier曲线法和Cox比例风险模型来确定置管途径对初始通畅率的影响，并对导管失败的临床风险因素进行校正。
620例患者共进行了967次带隧道的透析导管置入。右侧颈内静脉导管的中位存活时间为569天。多变量分析后，右侧颈内静脉、左侧颈内静脉（校正风险比[HR]，0.80；95%置信区间[CI]，0.52 - 1.21）、颈外静脉（HR，0.79；CI，0.33 - 3.13）、锁骨下静脉（HR，0.67；CI，0.58 - 2.44）和股静脉（HR，1.20；CI，0.36 - 1.33）导管的导管失败率无差异。各组之间在功能或并发症方面无重大差异。
本研究未发现带隧道的血液透析导管插入部位与导管存活之间存在统计学上的显著关系。当代血液透析血管通路的方法应根据特定患者情况进行调整。
