New possibilities of tunnel catheter implantation for programmed hemodialysis in patients with limited vascular access

Objective of the study: to evaluate the clinical efficacy and safety of a new method for implanting a tunneled central venous catheter (tCVC) at the confluence of the transverse cervical vein and the external jugular vein in patients undergoing programmed hemodialysis (PHD), compared with the traditional approach of placing the tCVC in the internal jugular vein.

Materials and methods: the study included 164 patients who underwent tCVC implantation for PHD in City Clinical Hospital No. 52 of the Moscow Health Department between August 2022 and December 2024. Group 1 (study group, n=82) comprised patients with occlusion of the internal jugular vein who received tCVC placement at the transverse-external jugular vein confluence. Group 2 (control group, n=82) comprised patients who underwent standard tCVC placement in the internal jugular vein. In both groups, catheter function, incidence and types of complications in the early and late postoperative period, and the feasibility of creating long-term vascular access (AVF) on the side of the previously implanted tCVC were assessed.

Results: Hemodialysis efficiency in patients with tCVC placed with the new technique was comparable to that in the control group. The flow rate (Me [IQR]) through tCVC was 300 [290; 300] ml/min. Blood collection and blood return pressures were 140 [140; 150] mmHg and -140 [-140; -130] mmHg, respectivelyю The Kt/V index was 1.60 [1.40; 1.60] (p=0.329) in the main and control groups. The frequency and types of complications, intraoperative and postoperative, did not differ between groups. AVFs were formed with similar frequency (54.9% in the main group and 53.7% in the control group (p=0.875)), and in most patients the possibility of AVF formation on the same side as the tCVC was preserved.

Conclusion: The proposed alternative method of tCVC placement can be effectively used in patients with limited vascular access for hemodialysis, such as those with the internal jugular vein occlusion. It avoids the need for catheter placement in the subclavian or femoral vein, while maintaining adequate hemodialysis efficiency and safety compared to the standard tCVC technique.

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