Tunneled hemodialysis catheter placement using anatomical landmarks and vein ultrasound: Clinical experience

Tunneled hemodialysis catheters are frequently required when permanent vascular access is unavailable or urgent dialysis initiation is necessary. Although fluoroscopy is commonly used to guide catheter placement, access to fluoroscopic facilities may be limited. This study reports a single‑center experience with tunneled hemodialysis catheter placement using anatomical landmarks, with ultrasound guidance, without routine immediate fluoroscopy.

A retrospective observational study was conducted including all consecutive tunneled hemodialysis catheter placements performed between February 2022 and February 2026 at a tertiary vascular surgery center. Catheters were inserted by vascular surgeons using ultrasound‑guided venous access and anatomical landmarks to estimate catheter length and tip position. Immediate fluoroscopy was used selectively in technically challenging cases. Outcomes included technical success, catheter tip position on post‑procedural imaging, need for reintervention, and peri‑procedural complications.

A total of 447 catheter-related procedures were performed in 384 patients (mean age 73.8 years). Catheter placement was completed without immediate fluoroscopy in 429 procedures (96.0%; 95% CI: 94.2-97.8). The right internal jugular vein was the most frequently used access site (72%). Overall technical success was achieved in 406 procedures (90.8%; 95% CI: 88.1-93.5). Post-procedural imaging demonstrated right atrial tip positioning in 86.0% of right internal jugular placements (95% CI: 82.2-89.8) and 66.7% of left internal jugular placements (95% CI: 56.1-77.3). Reintervention due to catheter dysfunction occurred in 41 procedures (9.2%; 95% CI: 6.5-11.9) and was more frequent following left internal jugular access (18.7% vs 7.1%; RR 2.61, 95% CI: 1.41-4.83). Periprocedural complications were infrequent and predominantly minor, with no mortality.

In this retrospective descriptive series, tunneled CVC insertion without fluoroscopic guidance was feasible and demonstrated an acceptable safety profile. These findings support the potential role of this approach in selected clinical settings; however, comparative studies are required to further evaluate its relative effectiveness.