Abstract: Objectives  To assess the correlation between the tip position of the right internal jugular vein (RIJV) catheter and clinical effects through three-dimensional (3D) reconstruction of chest computer tomography (CT) images.  Methods   This was a single centered, retrospective and cohort study. Chest CT images of the cases with tunneled cuffed catheter (TCC) in RIJV were reviewed. When the tip position of TCC was measured, the convergence of upper edge of the 4th rib and the right border of sternum was defined as the ordinate origin. The patients were divided to group thrombolysis (group T) and group non-thrombolysis (group NT) according to whether thrombolytic therapy for TCC was required. Clinical parameters, the tip position of TCC and outcomes of TCC were analyzed.  Results  A total of 47 patients were enrolled in this study, with 16 (34.04%) patients in group NT and 31 (65.96%) patients in group T. Patients in group NT had younger age (t= -2.860, P=0.006), lower CRP level (Z=-2.627, P=0.009), longer vertical distance from tip of TCC to origin point (t=2.108, P=0.041), and longer length of TCC inside the vessel (t=3.617, P=0.001) as compared with those in group T. Logistic regression showed that age (OR=1.069, 95% CI: 0.997~1.122, P=0.008), CRP (OR=1.270, 95% CI: 1.009~1.598, P=0.030), and the length of TCC inside the vessel (OR=0.967, 95% CI:0.920~0.993, P=0.005) were the independent risk factors for the requirement of thrombolytic therapy. When length of TCC inside the vessel was used to estimate the non-thrombolysis therapy for TCC, the best threshold length was 80.6 mm, the area under the curve of receiver operating characteristic (ROC) curve was 0.784 (95% CI: 0.634~0.931, P=0.002), and both the sensitivity and specificity were 100%. The prevalence of TCC-related infection was significantly higher in group T than in group NT (χ2=0.501, P=0.029).  Conclusion  The length of TCC inside RIJV can be used to estimate the possibility of long-term patency of TCC without thrombolytic therapy. For elder patients or patients with CRP higher than normal level, preventive thrombolysis treatment should be considered to get a longer patency of TCC.

Key words: Hemodialysis, Catheter, Computer tomography, Three-dimension, Outcome