Is it really well-positioned? Computed tomography vs. chest X-ray in the evaluation of hemodialysis catheters.

Abstract

Introduction: Proper positioning of the central venous catheter tip for hemodialysis is crucial to ensure efficient flow and reduce complications such as access dysfunction, thrombosis, arrhythmias, and vascular perforation. Chest radiography is the most commonly used method for post-procedure verification; however, computed tomography (CT) offers greater anatomical precision and is considered the gold standard for evaluating catheter tip location.

Materials and Methods: We conducted a retrospective analytical study using a database (n=185) of patients diagnosed with stage G5 chronic kidney disease (CKD) undergoing hemodialysis between January 2025 and June 2026. Patients were categorized into three groups: G1: Central stenosis (n=116/67%); G2: Vascular access exhaustion (n=56/30.2%); and G3: Catheter dysfunction (n=13/7%). Group 3 underwent CT scanning to compare the results with the conventional follow-up chest X-ray routinely performed after device placement. Images were analyzed in collaboration with a radiologist to determine the catheter tip location. This analysis focuses on Group 3.

Results: Patient ages ranged from 30 to 83 years (mean: 62.6). Twelve catheters were tunneled and one was temporary; nine were inserted via the jugular vein and four via the femoral vein. In six cases, the tip was located outside the atrium; two were positioned over common iliac artery stenoses; one was in the left common iliac vein, compressed by the overlying common iliac artery (May-Thurner syndrome); two showed kinking (one along the catheter tract and one at the tip); one was located in the external iliac vein; and in one case, the cause of dysfunction was not identified. Three patients underwent catheter repositioning, involving the withdrawal of approximately 3 cm of the catheter. One patient underwent no procedure, and eight received a new catheter placed under fluoroscopic guidance with angiographic monitoring.

Conclusion: Computed tomography is more accurate than chest radiography for determining the position of hemodialysis catheter tips and serves as the reference method in validation studies. However, its use should be reserved for complex cases or suspected malposition.