What is the recommended duration of use for a permanent catheter on the external jugular vein for hemodialysis?

Duration of Use for Permanent Catheter on External Jugular Vein for Hemodialysis

Permanent catheters in the external jugular vein for hemodialysis can be used for several months, but should be considered a temporary solution while awaiting more permanent vascular access options due to their higher complication rates compared to arteriovenous fistulas or grafts. 1, 2

Recommended Duration Guidelines

• Tunneled cuffed catheters (permanent catheters) can provide access over a period of months, improving chances of arteriovenous fistula maturation in patients who require immediate hemodialysis 3
• External jugular vein catheters have been used successfully with an average indwelling time of 3.46±2.21 months 4
• In one study, external jugular catheters functioned for an average of 3.12±1.22 months before requiring replacement or removal 4
• Tunneled cuffed catheters have a longer expected use-life than non-cuffed catheters but still shorter than arteriovenous fistulas or grafts 3

Site Selection Considerations

• The right internal jugular vein is the preferred site for permanent catheter placement due to its direct route to the caval atrial junction and lower complication rates 3, 5
• External jugular vein is considered an alternative access site when the internal jugular vein is not available 5
• Subclavian access should be avoided when possible due to the risk of central venous stenosis, especially in patients who may need permanent vascular access in the future 3, 5

Complications Affecting Duration of Use

Infection

• Infection is a major complication limiting the duration of catheter use 3
• Studies of external jugular catheters report local skin infection rates of 4.01% and catheter infection rates of 3.26% 4
• Tunneled cuffed catheters have lower infection rates compared to non-cuffed catheters 1
• Exit site, tunnel tract, or systemic infections should prompt removal of the catheter 3

Thrombosis

• Catheter thrombosis is reported in approximately 0.75% of external jugular catheters 4
• Thrombotic complications can manifest as catheter malfunction or symptoms of deep vein thrombosis 3
• The overall incidence of catheter-related deep vein thrombosis ranges from 27% to 66% (asymptomatic) and 0.3% to 28.3% (symptomatic) 3

Mechanical Issues

• Poor blood flow is a common issue, with approximately 4.01% of external jugular catheters having blood flow lower than 150 mL/min 4
• Catheter malfunction and mechanical damage are the main reasons for catheter exchange or removal 2

Monitoring and Maintenance

• Regular monitoring for signs of infection, thrombosis, and adequate blood flow is essential 1
• Fluoroscopy is mandatory for insertion of all cuffed dialysis catheters to ensure optimal catheter tip position 3
• The catheter tip should be positioned at the level of the caval atrial junction or into the right atrium to ensure optimal blood flow 3
• Real-time ultrasound-guided insertion is recommended to reduce insertion-related complications 3, 5

Recommendations for Optimizing Duration

• Use tunneled cuffed catheters rather than non-cuffed catheters for longer-term access 1
• Consider using anticoagulant locking solutions to prevent thrombosis 2
• Apply antimicrobial ointment at the exit site to reduce infection risk 2
• Remove catheters as soon as possible when no longer needed 1
• Plan for more permanent access options (arteriovenous fistula or graft) while using the catheter 3

Conclusion

While permanent catheters in the external jugular vein can function for several months (average 3-4 months), they should be considered a bridge to more permanent access options due to their higher complication rates and shorter expected use-life compared to arteriovenous fistulas or grafts 2, 4. Regular monitoring and proper maintenance are essential to maximize the duration of use and minimize complications 1.