CVC function during arm movement
Objectives: The main objectives of this study were to analyze right internal jugular vein tunneled dialysis catheter (TDC) tip displacements, functional changes, pathway deformity and angulation associated with different arm positions.
Methods: We prospectively studied 21 patients who underwent TDC implantation for hemodialysis via the right internal jugular vein in a single center, from February to September 2020. After implantation, a control resting fluoroscopy image was taken, and three “movement mimicking” images of the ipsilateral arm were obtained for comparison: arm in maximum abduction, maximum flexion, and maximum adduction. Device function was analyzed in each “movement mimicking” position and correlated to catheter tip displacement, catheter deformity and catheter pathway angulation.
Results: TDC pathway deformity occurred in 16 patients (69.5%). Deformities were more frequent in the “movement-mimicking” positions when compared to the control resting baseline images (p = 0.004). The different arm positions did not lead to significant tip displacement arm (either horizontal or vertical, p > 0.05), nor did they result in significant pathway angulation between the subcutaneous and intravenous regions (p = 0.114). Importantly, in the maximum abduction position, there was a positive relationship between the catheter pathway angle and impairment of catheter function (p = 0.028).
Conclusions: Catheter deformity is more frequent and more severe with the maximum adduction and flexion of the arm. Although there was no significant change in the tip of the catheter with the movements, there was a positive relationship between catheter pathway angle and impairment of catheter function in the maximum abduction position.
Okamoto GFT, Portela FSO, Alexandrino da Silva MF, Portugal MFC, Wolosker N, de Souza RCR, Teivelis MP, de Almeida Mendes C. Intraoperative evaluation of tunneled dialysis catheter mobility and function with arm movement. J Vasc Surg Venous Lymphat Disord. 2021 Oct 8:S2213-333X(21)00503-5. doi: 10.1016/j.jvsv.2021.09.010. Epub ahead of print. PMID: 34634517.