title: Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates.
abstract: OBJECTIVE
  To determine rates of dysfunction and infection for tunneled internal jugular vein hemodialysis catheters based on laterality of insertion and catheter tip position.
  
  
  METHODS
  Retrospective review of a procedural database for tunneled internal jugular vein hemodialysis catheter placements between January 2008 and December 2009 revealed 532 catheter insertions in 409 patients (234 male; mean age, 54.9 y). Of these, 398 catheters were placed on the right and 134 on the left. The catheter tip location was categorized as superior vena cava (SVC), pericavoatrial junction, or mid- to deep right atrium based on review of the final intraprocedural radiograph. The rates of catheter dysfunction and catheter-related infection (reported as events per 100 catheter-days) were analyzed.
  
  
  RESULTS
  Catheters terminating in the SVC or pericavoatrial junction inserted from the left showed significantly higher rates of infection (0.50 vs 0.27; P = .005) and dysfunction (0.25 vs 0.11; P = .036) compared with those inserted from the right. No difference was identified based on laterality for catheter tip position in the mid- to deep right atrium. Left-sided catheters terminating in the SVC or pericavoatrial junction had significantly more episodes of catheter dysfunction or infection than catheters terminating in the mid- to deep right atrium (0.84 vs 0.35; P = .006), whereas no significant difference was identified for right-sided catheters based on tip position.
  
  
  CONCLUSIONS
  When inserted from the left internal jugular vein, catheter tip position demonstrated a significant impact on catheter-related dysfunction and infection; this relationship was not demonstrated for right-sided catheters.
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
authors.forename: Bjorn I
authors.initials: BI
authors.lastname: Engstrom
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Horvath
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Stewart
authors.forename: Ryan H
authors.initials: RH
authors.lastname: Sydnor
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
mesh_terms: D055499:Catheter-Related Infections / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D015984:Causality; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000295:instrumentation* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: NKF; National Kidney Foundation; SVC; superior vena cava; tPA; tissue plasminogen activator