Experience With More Than 1,000 Cuffed Tunneled Hemodialysis Catheter Insertions Over Four Years at a Single Center

Introduction: Cuffed tunneled hemodialysis catheters are an important vascular access option for patients with end-stage renal disease (ESRD) when arteriovenous fistula (AVF) creation is not feasible or when urgent initiation of hemodialysis is required. However, clinical outcomes may vary according to the catheter insertion site. Objective: To compare procedural safety, biochemical outcomes, and six-month clinical outcomes among different tunneled hemodialysis catheter insertion sites. Methods: This retrospective observational study included 1,050 consecutive patients who underwent tunneled hemodialysis catheter insertion over four years at a tertiary care center. Patients were categorized according to catheter insertion site into right internal jugular vein (RIJV; n = 535), left internal jugular vein (LIJV; n = 416), subclavian vein (n = 53), and femoral vein (n = 46) groups. Baseline characteristics, procedure-related complications, laboratory outcomes at three months, and clinical outcomes at six months were compared using appropriate statistical analyses. Results: Baseline demographic and laboratory characteristics were comparable among all groups (all P > 0.05). Procedure-related complications were significantly more frequent in the subclavian and femoral groups, including exit-site bleeding (P = 0.032), catheter malposition (P = 0.028), hematoma formation (P = 0.018), arterial puncture (P = 0.022), hypoxia (P = 0.036), arrhythmia (P = 0.041), and pneumothorax (P = 0.048). At three months, patients with subclavian and femoral access demonstrated significantly poorer biochemical profiles, characterized by lower hemoglobin and serum albumin levels and higher leukocyte counts, serum creatinine, C-reactive protein, phosphorus, and intact parathyroid hormone levels (all p<0.05). At six months, internal jugular vein access was associated with significantly higher rates of successful AVF creation (P = 0.018) and ongoing catheter survival (P = 0.012). Conversely, subclavian and femoral access were associated with significantly higher rates of catheter dysfunction (P = 0.015), catheter-related bloodstream infection (P = 0.013), and mortality (P = 0.020). Conclusions: Internal jugular vein access, particularly RIJV access, was associated with superior procedural safety, more favorable biochemical profiles, and better six-month clinical outcomes compared with subclavian and femoral access. These findings support the preferential use of internal jugular vein access for tunneled hemodialysis catheter placement whenever feasible.