Hemodialysis vascular catheter tip position ‒ Relationship with catheter‒related problems and effective blood flow rate： A retrospective cohort study

Abstract

In hemodialysis using vascular catheters (VC), inadequate blood flow can lead to decreased dialysis efficiency due to increased re‒circulation rates and downtime caused by thrombosis or circuit occlusion. Therefore, appropriate VC tip positioning is critical to avoid VC‒related issues. However, quantitative studies evaluating the relationship between the VC tip position and blood flow characteristics are limited. In this study, we utilized records from 178 patients who received VC‒based hemodialysis conducted from 2019 to 2022 to evaluate the relationship between VC tip positioning and blood flow rates, dialysis efficiency, and safety, focusing on the internal jugular and femoral veins, respectively. Maximum effective blood flow rates were calculated by subtracting re‒circulation from maximum achievable blood flow rates. VC‒related problem rates were categorized into four stages and verified. As a result, positioning of the tip caudal to the carina in the internal jugular vein, and positioning it cranial to the Jacoby line in the femoral vein, were associated with high maximum effective blood flow rates and low rates of VC‒related problems. When performing dialysis using VC, placing the tip in these positions may lead to higher dialysis efficiency and potentially avoid VC‒related issues.