Can a central line be placed in the internal jugular vein on the same side as a brachial arteriovenous fistula?

Can Central Line Be Placed in IJV on Same Side as Brachial Fistula?

You should avoid placing a central venous catheter in the internal jugular vein ipsilateral (same side) to a brachial arteriovenous fistula whenever possible, as this significantly compromises fistula patency and increases complications.

Primary Recommendation

The 2020 KDOQI guidelines explicitly state that when central venous stenosis or pathology exists on one side that limits AV access creation but still allows CVC insertion, "this side should be used for the CVC to preserve the other side for AV access creation" 1. This principle applies in reverse: if an AV fistula already exists on one side, place the CVC on the contralateral side to preserve the functioning access.

The 2025 Association of Anaesthetists guidelines reinforce this by emphasizing preservation of vessels used for arteriovenous fistula creation, stating that "catheterisation of central veins for reasons other than renal replacement therapy should also be avoided, due to the risk of stenosis or loss of patency" 2.

Evidence Supporting Contralateral Placement

Research demonstrates clear harm from ipsilateral placement:

• A 2019 study showed dramatically reduced fistula survival when catheters were placed ipsilateral to the AVF (247 days) versus contralateral (779 days), with ipsilateral placement being an independent predictor of fistula failure 3
• The mechanism involves increased risk of central venous stenosis/thrombosis, which when combined with high-flow AVF, can cause severe venous hypertension and limb complications 4

Algorithmic Approach to CVC Site Selection

When a patient has a functioning brachial AVF:

1. First choice: Contralateral internal jugular vein
2. Second choice: Contralateral external jugular vein
3. Third choice: Femoral vein (if short-term use <1 month and no contraindications)
4. Avoid: Ipsilateral IJV, subclavian veins bilaterally (risk of central stenosis)

Right-sided placement is generally preferred over left due to more direct anatomy 1, so if the AVF is on the left arm, the right IJV is ideal.

Critical Caveats

• If you absolutely must use the ipsilateral IJV (no other options available), understand this creates high risk for:

  • Central vein stenosis/thrombosis
  • Venous hypertension in the limb
  • AVF dysfunction or failure
  • Need for complex venous reconstruction procedures 4, 5

• Remove the catheter as soon as clinically feasible to minimize exposure time and stenosis risk

• Consider the patient's long-term dialysis "life-plan" - preserving vascular access options is paramount for ESKD patients 1, 2

Common Pitfall

The most common error is placing CVCs without considering existing or planned vascular access. Always ask about dialysis access before any central line placement in CKD/ESKD patients. A seemingly convenient ipsilateral IJV placement can destroy a functioning fistula that took months to mature and may be the patient's only viable access option.