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164 EVALUATION OF INTERNAL JUGULAR VEIN THROMBOSIS IN DIALYSIS PATIENTS WITH LARGE TUNNELED CATHETERS.
  1. J. D. Walton1,
  2. A. A. Khan1,
  3. B. M. Wall1
  1. 1Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, TN.

Abstract

Purpose To evaluate the prevalence of internal jugular vein thrombosis in patients with large diameter (16 French) tunneled dialysis catheters to determine if the larger diameter catheters are associated with increased thrombosis rates.

Methods and Materials A retrospective chart review of dialysis-dependent end-stage renal disease patients at the Memphis VAMC was performed to identify patients who had received tunneled internal jugular catheters for hemodialysis. Since 2002, large-diameter, 16 French Ash-Split catheters have been primarily used. Eligible patients were those with 16 French catheters placed from January 1, 2002, to October 1, 2006. A total of 60 patients were identified. Additional information obtained from patient records included catheter site placement, number of catheters placed in each site, history of hypertension, history of diabetes mellitus, and number of catheter-related infections.

Results All of the 60 patients were men. A diagnosis of hypertension was present in 85% (51 of 60) and diabetes mellitus was present in 35% (21 of 60). These percentages are similar to the overall prevalence of hypertension and diabetes mellitus seen in ESRD patients at this center. In 7 of the 60 patients in the study, bilateral internal jugular veins were used for tunneled catheter placement; thus, the total number of access sites was 67. Thrombosis was present in 16.4% (11 of 67) of the total number of catheter access sites. Of the total number of thromboses present, 63.6% (7 of 11) were in the right internal jugular vein and 36.4% (4 of 11) in the left internal jugular vein. Also, of the 11 thromboses present, 82% (9 of 11) of the occlusions were associated with catheter-related infections.

Conclusion Previous studies have reported the prevalence of internal jugular thrombosis in patients with standard dialysis catheters (14.5 French) to be around 10 to 25%. The prevalence of thrombosis demonstrated in this study shows no increased rate of thrombosis with larger catheters. There was an extremely high frequency of catheter-related infections in patients with thrombosis.

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