Figure 519

Right internal jugular vein catheters. The use of central vein catheters has grown significantly over the past several years. These catheters were at one time used only on a temporary basis and served as a "bridge" to permanent vascular access. Improvements in catheter design and function combined with ease of insertion have increased use of central vein catheters in dialysis units. To minimize the risk of central vein stenosis and subsequent thrombosis, central vein catheters should be inserted preferentially into the right internal jugular vein, regardless of whether they are being used for temporary or more permanent purposes. The typical positioning of a double-lumen catheter, A, is with its tip at the junction of the right atrium and the superior vena cava. The catheter has been "tunneled" underneath the skin so that the exit site (large arrow) is located just beneath the right clavicle and distant from the insertion site (small arrow). This catheter also has a cuff into which endothelial cells will grow and produce a biologic barrier to bacterial migration. B, Chest radiograph showing a dialysis central vein catheter that is composed of two separate single-lumen catheters that have been inserted into the right internal jugular vein. The distal tip of the venous catheter is positioned just above the right atrium. Care must be taken, however, to ensure proper placement of catheters with this type of design, because the two single lumens are radiographically indistinguishable.

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