A Retrospective Study of External Jugular Vein Access in 50 CKD Patients on Regular Hemodialysis in Thi-Qar (2013-2022)

Background: Vascular venous access is considered the life line of CKD patients on regular
hemodialysis, and fortunately updates appear continuously in this complicated field leading to
improvement of approach to the venous access of the CKD patients. During hemodialysis, the
patient's blood is removed so that it can be cleaned from it's high level of urea, creatinine,
electrolytes and harmful salts through the dialysis machine. Catheter access, sometimes called
a CVC (central venous catheter), consists of a plastic catheter with two lumens which is
inserted into a large central vein to allow large amounts of blood to be withdrawn from one
lumen, to enter the dialysis machine, and to be returned back to the patient's body via the other
line lumen. Aim of study: The purpose of this study was showing a new & unique vascular
access which is not popular among vascular surgeons. Patients & Methods: Our study is a
retrospective one of fifty patients for whom a double lumen catheter was inserted via the
external jugular vein into the central & deep veins of chest under local anaesthesia over a
period of about nine years (from March 2013 till February 2022). Results: This unique
method of vascular access had been applied nearly similarly on both genders and a significant
number (40%) of the CKD patients were older than 40 years. In (90%) of CKD patients, the
right external juglar vein was chosen for vascular access rather than the left side (10%). Most
complications were expected and treatable and no disastrous events had been recorded. In
(80% ) of patients the line of external jugular vein access remained for more than 6 months and
this advantage is similar to that of the tunneled double lumen catheter and even to the
peripherally inserted central catheter (PICC line) but inferior to the Implantable ports while
only (20%) of this unique venous access remained for a duration less than 6 months.
Conclusion & Recommendations:
1- During this unique technique, the catheter is inserted exclusively via the external jugular
vein.
2- It is indicated usually in critically ill CKD patients on regular hemodialysis for whom a
double lumen catheter insertion in the ordinary site is not possible.
3- It is usually carried out under local anaesthesia with minimal complication rate.
4- This durable and unique vascular access remains the last option for CKD patients on regular
hemodialysis with thrombosed and stenosed internal jugular, subclavian, femoral,
brachiocephalic and possibly other deep and central veins of the trunk.
5- Aseptic technique for accessing venous system is mandatory to avoid infection and it's
serious consequences.
6- Fluoroscopy may become mandatory and a solid part of our new technique in the future
because it shortens time of procedure and increases number of patients on which our new
technique may be applied.