Abstract: 【Abstract】Objective The purpose of this study was to assess the feasibility and safety of placement of tunneled cuffed catheters by Nelf Percutaneous Acces Set in patients with occluded right and left innominate veins. Method It was a retrospective review of the use of Nelf Percutaneous Acces Set in tunneled catheter placement in patients with right and left innominate vein occlusions between April 2018 and August 2019. In all cases, the puncture needle was directed and advanced toward the angiographic catheter placed on the central side of the superior vena cava under fluoroscopic guidance. And then exchanged the guidewire and placed a tunneled central venous catheter. The outcome measures evaluated were technical success rate, catheter patency,
and complication rate. Results The procedure succeeded in all 35 patients. During follow-up [10 (6, 20) months], access failure was observed in two patients. The remained patients functioned well until the end of the follow-up period or until the death of the patient (n=1). No procedurErelated major complication occurred. The most common complication was mediastinal hematoma after puncture failure in three patients. The diameter of the maximum hematoma was 1.8 cm, and all resolved spontaneously. Conclusion In patients with exhaustion access, a tunneled central venous catheter can be safety placed by Nelf Percutaneous
Acces Set through the transcutaneous route.

Key words: Hemodialysis vascular access, Central venous catheterization, Occlusion of innominate vein, Exhausted access