Background: The small bore internal jugular (SBIJ) catheter is to be used for central access in all patients with chronic kidney disease (CKD) Stage 3 or higher (MDRD eGFR <60ml/min), end-stage renal disease (ESRD) or kidney transplant. Transplant recipients often require central vein access and maintenance of vein patency is critical despite a functioning graft. To date, the safety of SBIJ use or the incidence rates of thrombosis/stenosis complications of its placement have not been evaluated.

Methods: Patients undergoing kidney transplant or post-kidney transplantation regardless of kidney function were enrolled by written consent in this prospective single-center trial. Subjects were screened for inclusion by daily review of the University of Chicago Procedure Service and Surgical logs by a Nephrologist. Qualified patients were scheduled for SBIJ placement in Interventional Radiology. A venous Doppler was performed at both time of insertion and removal of the SBIJ. Demographic data included: indication for placement, number of catheter days and kidney function measured by MDRD eGFR.

Results: Nineteen patients were enrolled from December 1^st, 2010 to December 31^st, 2012 with 21 SBIJs placed. Two patients had catheters placed on 2 separate hospitalizations. Indications for SBIJ placement included central access for induction therapy (n=13, 61.9%), systemic antibiotics (n=6, 28.6%), rejection of allograft (n=1, 4.8%) and combined rejection/antibiotic therapy (n=1, 4.8%). Catheter days varied between 4-43 days (ave. 12 days). In the induction immunosuppression group (n=13) eGFR ranged from 3-47ml/min (ave. 15.08ml/min) and in individuals post-kidney transplantation, values were 5-86ml/min (ave. 29.6ml/min), averaging well into the CKD Stage 4 or higher category for both. Of patients with venous Doppler at line removal (n=20, 95.2%), no evidence of thrombosis and/or stenosis was found in 100% of patients. None of the 21 line placements/removals resulted in injury or harm.

Conclusions: PICC placement is common and can result in deep vein thrombosis and/or central vein stenosis. These complications preclude use of peripheral veins for future dialysis access should it be required. Vein/access preservation for the kidney transplant recipient must be prioritized as in the CKD/ESRD population. The SBIJ is safe and must be preferred in all transplant recipients regardless of allograft function.

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