Abstract: 【Abstract】Objective To study the determination method of subcutaneous tunnel length during left internal jugular vein catheterization under the guidance of digital subtraction angiography (DSA). Methods Forty- four maintenance hemodialysis patients were enrolled in this study. In the experimental group (n=22), catheter sheath was indwelled after puncture of left internal jugular vein. The 4F endovascular angiographic catheter was then inserted through the catheter sheath under the guidance of DSA, ensuring that the catheter tip was located in the middle upper part of right atrium. The site of angiographic catheter out of the catheter sheath was labeled on body surface. The angiographic catheter was then withdrawn and the length of the catheter entering the body was measured. Based on this length, subcutaneous tunnel length of the dialysis catheter with cuff was determined. In the control group (n=22), subcutaneous tunnel length of the dialysis catheter with cuff was roughly determined by the osseous marker on body surface. Results In the 22 patients in experimental group, the tips of left internal jugular vein catheters were located in middle or middle upper part of right atrium. The subcutaneous tunnel length was appropriate and no longer or shorter length occurred. In the 22 patients in control group, the tips of the catheters were located in middle or middle upper part of atrium in 14 cases, in inferior atrium in 7 cases and in superior vena cava near atrium in one case. The dialysis blood flow was >250 ml/min in all cases on the day of operation and the second day. Within 6 months after operation, catheter tips moved upward in 3 cases (two females and one male). Catheter tips moved slightly upward in 39 of the 44 cases. The dialysis catheter slipped out and must be replaced in one case in control group. Conclusions The subcutaneous tunnel length during left internal jugular vein catheterization can be accurately determined through insertion of an endovascular angiographic catheter under the guidance of DSA. Most of the tip of dialysis catheter with cuff via left internal jugular vein may move upward slightly after catheterization.

Key words: Hemodialysis,  Digital subtraction angiography, Left internal jugular vein catheterization, Subcutaneous tunnel, Endovascular angiographic catheter