Department of Nephrology, Cairns Hospital, Cairns, QLD, Australia.
Division of Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
Vasc Endovascular Surg. 2024 Feb;58(2):136-141. doi: 10.1177/15385744231196651. Epub 2023 Aug 27.
The impact of technical differences in cannulation technique for tunnelled haemodialysis catheter insertion is undetermined. We aimed to assess clinical outcomes of the low posterior approach for internal jugular vein tunnelled catheter placement.
A retrospective audit was undertaken on consecutive tunnelled catheter procedures performed at a single centre between January 2016 and June 2022. Only catheters specifically placed with a low posterior internal jugular approach were included. The study's primary outcome was 12-month catheter survival, evaluated using the Kaplan-Meier survival curve and log-rank test. Secondary outcomes included catheter performance and procedure-related complications.
During the study period, 391 tunnelled internal jugular haemodialysis catheters were inserted in 272 patients using the low posterior technique. The 12-month primary patency rate was 68%. Catheter insertion was successful in 96% of cases. Peri-procedural complications occurred in 4% of cases, most frequently bleeding. The most common reasons for catheter loss were dysfunction (10%) and bacteraemia (6%). The best predictors of catheter failure were advanced age (HR 1.02, 95% CI 1.00-1.04) and in-centre dialysis treatment locality (HR 2.04, 95% CI 1.19-3.45).
The low posterior approach for internal jugular vein tunnelled catheter insertion is effective and safe. We demonstrated a 12-month catheter survival rate of 68%. Further research comparing the low posterior approach with other internal jugular vein cannulation techniques is warranted.
导管置管技术差异对隧道式血液透析导管插入的影响尚不确定。本研究旨在评估低位后入路在颈内静脉隧道式导管放置中的临床效果。
对 2016 年 1 月至 2022 年 6 月期间在单中心连续进行的隧道式导管手术进行回顾性审核。仅纳入采用低位后入路专门放置的导管。本研究的主要结局是使用 Kaplan-Meier 生存曲线和对数秩检验评估 12 个月的导管生存率。次要结局包括导管性能和与手术相关的并发症。
在研究期间，272 例患者采用低位后入路技术共置入 391 根隧道式颈内静脉血液透析导管。12 个月的主要通畅率为 68%。96%的病例导管插入成功。4%的病例发生围手术期并发症，最常见的是出血。导管丢失的最常见原因是功能障碍（10%）和菌血症（6%）。导管失效的最佳预测因素是高龄（HR 1.02，95%CI 1.00-1.04）和中心透析治疗地点（HR 2.04，95%CI 1.19-3.45）。
低位后入路颈内静脉隧道式导管插入术安全有效。我们证明了 12 个月的导管生存率为 68%。需要进一步研究比较低位后入路与其他颈内静脉置管技术。
