Critical Care Time 60. Journal Club: Should We Save The Right IJ?
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Oct 6, 2025 Hosts dive into a debate on whether the right internal jugular vein (IJ) should be preserved for future procedures. They review a critical study on hemodialysis catheter complications, revealing higher reinsertion rates associated with initial right IJ placements. Methodological flaws spark lively critique, addressing selection bias and infection risks linked to guidewire exchanges. The conversation also touches on anatomical advantages, practical experiences, and emphasizes the importance of safe, informed site selection for optimized patient care.
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Institutional Bias Shapes Line-Placement Studies
- Some ICUs favor placing initial CVCs in the left IJ to 'save' the right IJ for future HD or PA catheters.
- This institutional practice drives variability and motivated the retrospective study discussed.
Study Design Narrowly Targets Two-Line Patients
- The discussed study was a single-center retrospective cohort at University of Maryland ICUs from 2019–2022.
- It included adults who had an internal jugular CVC and later required a temporary hemodialysis catheter.
Right-First CVCs Linked To More HD Reinsertions
- Among 214 patients who had a CVC then later an HD catheter, right-first CVCs were linked to much higher HD recatheterization rates.
- The paper reported 40% reinsertions for right-first versus 2.6% for left-first, a large association.