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Central Venogram Catheter Exchange Planning — ESENeph MCQ

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ModerateHaemodialysisCentral Venogram Catheter Exchange PlanningESENeph

A 66-year-old woman on haemodialysis has a tunnelled catheter placed in the right internal jugular vein. She develops catheter dysfunction with poor blood flow rates. A tissue plasminogen activator (alteplase) lock was tried without success. Catheter exchange over guidewire is planned. What is the MOST important imaging investigation before the exchange?

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Correct answer: D — CT venogram or catheter-directed venogram of central veins

Before catheter exchange, assessment of central vein patency is essential. Repeated central venous catheterisation causes progressive central venous stenosis or thrombosis (particularly subclavian and brachiocephalic veins). A venogram (catheter-directed or CT venography) delineates the anatomy, identifies stenoses amenable to angioplasty, and confirms adequate vessel calibre for a new catheter. Without this, blind exchange risks failed placement or perforation. Central venous stenosis is a leading cause of exhaustion of dialysis access options. This emphasises why AV fistula is preferred long-term and why subclavian catheters are avoided.

Reference: UKKA 2020 – Vascular Access Guidelines; ESVS 2018 – Vascular Access