Fluoroscopy-guided catheter tip positioning optimization: 10–30 mm beyond landmarks is associated with reduced intrathoracic central venous stenosis risk in hemodialysis patients

Fluoroscopy overestimates the cavoatrial junction position. Given that right atrium placement reduces intrathoracic central venous stenosis risk, advancing the catheter tip 10-30 mm beyond fluoroscopically guided landmarks constitutes a key maneuver for achieving accurate positioning. Implementation of this optimization strategy is associated with a 5.78-fold reduction in odds of intrathoracic central venous stenosis, providing actionable optimization for hemodialysis access management.