title: A comparison between blood flow outcomes of tunneled external jugular and internal jugular hemodialysis catheters.
abstract: OBJECTIVE
  The right internal jugular (RIJ) vein is preferred for placement of long-term venous catheters (CVC) for hemodialysis (HD). Use of left IJ vein potentially depletes the access site for arteriovenous fistula (AVF) or arteriovenous graft (AVF) placement because of the high rates of central venous stenosis. The right external jugular (EJ) vein is a viable alternative to the LIJ. The purpose of this study is to compare blood flow outcomes in a series of percutaneously placed external jugular (EJ), LIJ and RIJ HD catheters.
  
  
  METHODS
  Using a prospectively collected database, we identified 46 hemodialysis patients who received a tunneled catheter during a 4-year period. Blood flow outcomes of RIJ, LIJ, and EJ catheters that were date-matched over the study period were compared. Using ANOVA, the blood flow outcomes of the 3 tunneled catheter techniques at 30-d and 90-d were compared.
  
  
  RESULTS
  The 90-d blood flow outcomes of the 3 groups did not differ significantly. The 30-d blood flow was found to be 348.5± 56.62, 341± 22.42, and 365.7± 71.76 mL/min for RIJ, LIJ, and EJ respectively (P<.05). Using multiple regression analysis, no covariates (age, sex, race, diabetes) were found to be associated with blood flow outcomes at 30-d or 90-d. No identifiable factors were found to be associated with the difference in blood flow between 30-d and 90-d either.
  
  
  CONCLUSIONS
  EJ blood flow outcomes at 30-d and 90-d were comparable to both LIJ and RIJ historic data. Further prospective investigation is required to define the role of EJ CVC placement as another potential long-term access modality.
authors: Section of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 52713, USA. hvats@uwhealth.org
authors: Hemender S
authors: HS
authors: Vats
authors: Janet
authors: J
authors: Bellingham
authors: Jason W
authors: JW
authors: Pinchot
authors: Henry N
authors: HN
authors: Young
authors: Micah R
authors: MR
authors: Chan
authors: Alexander S
authors: AS
authors: Yevzlin
mesh_terms: D000704:Analysis of Variance; D001783:Blood Flow Velocity; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012039:Regional Blood Flow; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D014922:Wisconsin