Abstract: 【Abstract】Objectives To explore the factors relating to success and safety of tunneled central venous catheterization via internal jugular vein. Methods We conducted a retrospective study on patients undergoing tunneled central venous catheterization via internal jugular vein during 2011 to 2019. Demographic information and operation-related data, including location of the catheter, utilization of X-ray examination, cause of catheterization failure, intervention method, cause of intervention failure, and many others were recruited. The main termination point of the study was the rate of successful catheterization and the cause of catherization failure. Results A total of 1,598 patients were included in this study, with the average age of 63.27±11.86 years old, 659 males (41.2%), and X-ray utilization rate of 34.7%. The overall rate of successful catheterization was 95.4% (1,525/1,598). The rates of successful catheterization with and without x- ray examination were 97.8% and 94.2% respectively (χ²=11.292, P=0.001). The rate of successful catheterization via right internal jugular vein was higher than that via left internal jugular vein (96.6% vs. 90.1%; χ²=22,375, P<0.001). In the patients X-ray examination was not used, the rates of successful catheterization via right internal jugularvein and left internal jugular vein were 95.9% and 76.8% respectively (χ²=56,871, P<0.001); while in the
patients X-ray examination was used, the rates of successful catheterization via right and left jugular veins had no difference (98.4% vs. 96.8%; χ²=1.424, P=0.233). The causes of catheterization failure included ectopic tip of the catheter (endovascular ectopic or extravascular ectopic tip of the catheter), obstruction of guide wire insertion without the help of X-ray examination, and failure of interventional central vein opening. X-ray was not used in all ectopic catheter tip cases, accounting for 3.3%(34/1,043) of the patients without X-ray examination. In patients without X-ray examination, catheterization failure due to obstruction of guide wire insertion was found in 27 cases. In the 237 cases interventional operation was performed to manage the catheterization failure, the catheterization was finally successful in 225 cases, and was failure in 12 cases. Multivariate logistic regression analysis showed that left internal jugular vein catheterization (OR=1.700, 95% CI: 3.203~9.362, P<0.001) and no X-ray examination during catheterization (OR=1.653, 95% CI: 2.650~10.28, P<0.001) were the independent risk factors for failure of the catheterization. Conclusion The application of X-ray examination can increase the success rate of tunneled central venous catheterization via internal jugular vein. X-ray examination was more advantageous when left internal jugular vein was used for the catheterization

Key words: tunneled central venous catheter, internal jugular vein, hemodialysis