Tip position and clinical outcomes of right femoral tunneled cuffed hemodialysis catheters: a single-center retrospective study_West China Medical Journal

Authors：

WU Sudan ¹ , HUANG Dan ¹ , WANG Qiqi ² , WU Shaobo ¹ , WEI Haijun ² ,  HU Qiongdan ¹

1. Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, P. R. China;
2. Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, P. R. China;

Corresponding?author：

HU Qiongdan, Email: 156322801@qq.com

Keywords：

Hemodialysis; femoral tunneled cuffed hemodialysis catheter; catheter tip position; primary patency; catheter dysfunction; catheter-related infection

DOI：

10.7507/1002-0179.202606083

Video：

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Objective To evaluate the associations of the tip position of right femoral tunneled cuffed hemodialysis catheters with primary catheter patency and catheter-related complications. Methods This single-center retrospective cohort study included maintenance hemodialysis patients who underwent right femoral tunneled cuffed catheter (TCC) placement at the Hospital of Chengdu University of Traditional Chinese Medicine between August 2019 and August 2024. Catheter tip position was determined by postprocedural venography or fluoroscopy and classified as the inferior vena cava (IVC) group (catheter tip positioned within the lumen of the IVC) or the non-IVC group (atheter tip located in the iliac vein or more distal veins). Propensity score matching at a 1∶1 ratio was performed using age, sex, and dialysis vintage as covariates; catheter length distribution was compared after matching. Follow-up data were obtained from outpatient and inpatient records, dialysis-center records, imaging data, and telephone follow-up. The primary outcome (primary catheter patency) and secondary outcomes (catheter dysfunction and catheter-related complications) were compared between the two groups. Results A total of 66 patients were included. After matching, 26 patients were included in each group. In the non-IVC group, 18 patients (69.2%) used 23-cm catheters and 8 (30.8%) used 28-cm catheters; in the IVC group, 10 patients (38.5%) used 23-cm catheters and 16 (61.5%) used 28-cm catheters, and the difference was statistically significant (χ²=4.950, P=0.026). Primary patency did not differ significantly at 1 month (96.2% vs. 100.0%, P=1.000), whereas the IVC group had higher primary patency at 3, 6, and 12 months than the non-IVC group (88.5% vs. 61.5%, P=0.025; 80.8% vs. 50.0%, P=0.020; 57.7% vs. 23.1%, P=0.011). Kaplan-Meier analysis showed a significant difference in dysfunction-free catheter survival between groups (log-rank P=0.013). Catheter-related thrombosis, central venous stenosis, and catheter-related infection did not differ significantly between groups (P>0.05). Multivariable Cox regression showed that height ≥169 cm was a risk factor for catheter dysfunction [hazard ratio (HR)=6.06, 95% confidence interval (CI) (2.02, 18.16), P=0.001], whereas catheter tip placement in the IVC was protective [HR=0.30, 95%CI (0.12, 0.72), P=0.008]. Conclusion In patients receiving right femoral TCCs, tip placement in the IVC may improve primary catheter patency and reduce catheter dysfunction; further prospective multicenter studies with larger samples are needed.

Citation： WU Sudan, HUANG Dan, WANG Qiqi, WU Shaobo, WEI Haijun, HU Qiongdan. Tip position and clinical outcomes of right femoral tunneled cuffed hemodialysis catheters: a single-center retrospective study. West China Medical Journal, 2026, 41(7): 1089-1095. doi: 10.7507/1002-0179.202606083 Copy

1.	Santoro D, Benedetto F, Mondello P, et al. Vascular access for hemodialysis: current perspectives[J]. Int J Nephrol Renovasc Dis, 2014, 7: 281-294.
2.	Rossing P, Caramori ML, Chan JCN, et al. Executive summary of the KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease: an update based on rapidly emerging new evidence[J]. Kidney Int, 2022, 102(5): 990-999.
3.	Sulek CA, Blas ML, Lobato EB. A randomized study of left versus right internal jugular vein cannulation in adults[J]. J Clin Anesth, 2000, 12(2): 142-145.
4.	Shindo M, Takemae H, Kubo T, et al. Availability of the right femoral vein as a route for tunneled hemodialysis catheterization in hemodialysis patients with low activity[J]. Saudi J Kidney Dis Transpl, 2021, 32(3): 885-886.
5.	Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates[J]. J Vasc Interv Radiol, 2013, 24(9): 1295-1302.
6.	中國血液透析用帶隧道帶滌綸套中心靜脈導管的置入、更換及拔除專家共識編寫組. 中國血液透析用帶隧道帶滌綸套中心靜脈導管的置入、更換及拔除專家共識(第 1 版)[J]. 中國血液凈化, 2026, 25(4): 265-277.
7.	Wang L, Wei F, Jiang A, et al. Longer duration of catheter patency, but similar infection rates with internal jugular vein versus iliac vein tunneled cuffed hemodialysis catheters: a single-center retrospective analysis[J]. Int Urol Nephrol, 2015, 47(10): 1727-1734.
8.	Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
9.	Wang L, Wei F, Chen H, et al. Long-term outcome of posterior approach insertion of tunneled cuffed catheter: a single clinic retrospective analysis[J]. J Vasc Access, 2021, 22(4): 547-554.
10.	中華醫學會腎臟病學分會專家組. 透析通路中國指南(2024 年版)[J]. 中華腎臟病雜志, 2024, 40(12): 990-1070.
11.	Schutz JC, Patel AA, Clark TW, et al. Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement[J]. J Vasc Interv Radiol, 2004, 15(6): 581-587.
12.	崔銳, 鄭欣, 楊濤, 等. 1598 例經頸內靜脈帶隧道中心靜脈導管置入術分析[J]. 中國血液凈化, 2021, 20(2): 121-125.
13.	Premuzic V, Mihaljevic D, Pasini M, et al. Durability of tunneled catheters in children is associated with catheter tip depth: a single-center report[J]. Ther Apher Dial, 2021, 25(4): 490-496.
14.	Smith T, Kaufman C, Quencer K. Internal jugular central venous catheter tip migration: patient and procedural factors[J]. Tomography, 2022, 8(2): 1033-1040.
15.	Burton KR, Guo LL, Tan KT, et al. Patency of femoral tunneled hemodialysis catheters and factors predictive of patency failure[J]. Cardiovasc Intervent Radiol, 2012, 35(6): 1396-1402.
16.	血液透析通路相關中心靜脈病變介入治療專家組. 血液透析通路相關中心靜脈病變介入治療專家建議書[J]. 臨床腎臟病雜志, 2023, 23(4): 265-283.
17.	Yaqub S, Abdulrazzaque MR, Aftab A, et al. Outcomes of tunneled cuffed hemodialysis catheters: an experience from a tertiary care center in Karachi, Pakistan[J]. J Vasc Access, 2022, 23(2): 275-279.
18.	Poinen K, Quinn RR, Clarke A, et al. Complications from tunneled hemodialysis catheters: a Canadian observational cohort study[J]. Am J Kidney Dis, 2019, 73(4): 467-475.
19.	Radhakrishnan Y, Dasari J, Anvari E, et al. Tunneled femoral dialysis catheter: practical pointers[J]. J Vasc Access, 2023, 24(4): 545-551.

1. Santoro D, Benedetto F, Mondello P, et al. Vascular access for hemodialysis: current perspectives[J]. Int J Nephrol Renovasc Dis, 2014, 7: 281-294.
2. Rossing P, Caramori ML, Chan JCN, et al. Executive summary of the KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease: an update based on rapidly emerging new evidence[J]. Kidney Int, 2022, 102(5): 990-999.
3. Sulek CA, Blas ML, Lobato EB. A randomized study of left versus right internal jugular vein cannulation in adults[J]. J Clin Anesth, 2000, 12(2): 142-145.
4. Shindo M, Takemae H, Kubo T, et al. Availability of the right femoral vein as a route for tunneled hemodialysis catheterization in hemodialysis patients with low activity[J]. Saudi J Kidney Dis Transpl, 2021, 32(3): 885-886.
5. Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates[J]. J Vasc Interv Radiol, 2013, 24(9): 1295-1302.
6. 中國血液透析用帶隧道帶滌綸套中心靜脈導管的置入、更換及拔除專家共識編寫組. 中國血液透析用帶隧道帶滌綸套中心靜脈導管的置入、更換及拔除專家共識(第 1 版)[J]. 中國血液凈化, 2026, 25(4): 265-277.
7. Wang L, Wei F, Jiang A, et al. Longer duration of catheter patency, but similar infection rates with internal jugular vein versus iliac vein tunneled cuffed hemodialysis catheters: a single-center retrospective analysis[J]. Int Urol Nephrol, 2015, 47(10): 1727-1734.
8. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.
9. Wang L, Wei F, Chen H, et al. Long-term outcome of posterior approach insertion of tunneled cuffed catheter: a single clinic retrospective analysis[J]. J Vasc Access, 2021, 22(4): 547-554.
10. 中華醫學會腎臟病學分會專家組. 透析通路中國指南(2024 年版)[J]. 中華腎臟病雜志, 2024, 40(12): 990-1070.
11. Schutz JC, Patel AA, Clark TW, et al. Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement[J]. J Vasc Interv Radiol, 2004, 15(6): 581-587.
12. 崔銳, 鄭欣, 楊濤, 等. 1598 例經頸內靜脈帶隧道中心靜脈導管置入術分析[J]. 中國血液凈化, 2021, 20(2): 121-125.
13. Premuzic V, Mihaljevic D, Pasini M, et al. Durability of tunneled catheters in children is associated with catheter tip depth: a single-center report[J]. Ther Apher Dial, 2021, 25(4): 490-496.
14. Smith T, Kaufman C, Quencer K. Internal jugular central venous catheter tip migration: patient and procedural factors[J]. Tomography, 2022, 8(2): 1033-1040.
15. Burton KR, Guo LL, Tan KT, et al. Patency of femoral tunneled hemodialysis catheters and factors predictive of patency failure[J]. Cardiovasc Intervent Radiol, 2012, 35(6): 1396-1402.
16. 血液透析通路相關中心靜脈病變介入治療專家組. 血液透析通路相關中心靜脈病變介入治療專家建議書[J]. 臨床腎臟病雜志, 2023, 23(4): 265-283.
17. Yaqub S, Abdulrazzaque MR, Aftab A, et al. Outcomes of tunneled cuffed hemodialysis catheters: an experience from a tertiary care center in Karachi, Pakistan[J]. J Vasc Access, 2022, 23(2): 275-279.
18. Poinen K, Quinn RR, Clarke A, et al. Complications from tunneled hemodialysis catheters: a Canadian observational cohort study[J]. Am J Kidney Dis, 2019, 73(4): 467-475.
19. Radhakrishnan Y, Dasari J, Anvari E, et al. Tunneled femoral dialysis catheter: practical pointers[J]. J Vasc Access, 2023, 24(4): 545-551.

West China Medical Journal

Tip position and clinical outcomes of right femoral tunneled cuffed hemodialysis catheters: a single-center retrospective study

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