Vascular Access Recirculation in Hemodialysis Patients With Two Noncuffed, Single-lumen, Jugular Catheters in the Same Jugular Vein Janko Kovac ˇ, Jadranka Buturovic ´-Ponikvar, and Rafael Ponikvar Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia Abstract: Having achieved excellent results with single- lumen temporary hemodialysis catheters as a long-term vascular access in our center, in this study we examined the amount of vascular access recirculation in the case of using two single-lumen catheters in a single jugular vein. In 11 adult end-stage renal disease patients on chronic hemodi- alysis (HD), vascular access recirculation was studied using a thermodilution technique during dialysis at our center. The vascular access in all patients consisted of two pre- curved, 15 cm-long, 8-Fr catheters inserted in the right jugular vein. Recirculation measurements were performed with the blood flow set to 250 mL/min in all patients. In five patients, additional measurements were performed with the blood flow set to 200 mL/min. During 16 HD proce- dures, 55 recirculation measurements were taken. The rate of recirculation was <15% in 50 measurements, between 15% and 20% in four measurements, and >20% in one measurement. The average recirculation rate during a single procedure was <15% in 10 patients, and 16.2% in one patient. We did not find any significant differences in the recirculation rates measured either at higher or lower blood flow rates.The clinical importance of vascular access recirculation was noted in a single patient. Vascular access recirculation in hemodialysis patients with two single- lumen catheters in the same jugular vein is mostly accept- able. Some measures for preventing clinically important recirculation are also suggested. Key Words: Catheters, Hemodialysis, Jugular vein, Thermodilution, Vascular access. Good vascular access is a milestone in providing efficient and state-of-the-art hemodialysis (HD) treatment (1,2). In some patients, arteriovenous fis- tulas are not functional or cannot be constructed for a number of reasons described elsewhere (3). In those patients, central venous catheters are the vas- cular access of choice and, as suggested in literature, double-lumen catheters are recommended (4). If a catheter is to be a permanent HD vascular access in a patient, a tunneled catheter is recommended by various HD guidelines (5); however, in our experi- ence, HD patients and personnel are often con- fronted with the malfunction of at least one or both catheter lumens in double-lumen catheters. Malfunc- tions of central venous catheters can be treated in several different ways described elsewhere (6). Central venous catheter replacement is a procedure that often cannot be avoided. At our center we have excellent experience with the use of two single-lumen catheters for vascular access in patients with acute renal failure (7), and very good results with temporary HD catheters used as long-term vascular access in chronic HD patients (8). Since “single-needle” dialysis over one single- lumen catheter often does not fulfill the demands of state-of-the-art HD treatment, we decided to use two single-lumen catheters in chronic HD patients instead. These can be inserted into the same vein or into two different jugular veins. Another reason for choosing single-lumen catheters is that the replace- ment of a malfunctioning single-lumen catheter is a much less traumatic procedure than in the case of a much thicker, double-lumen catheter (7). The cath- eter performance of double-lumen HD catheters has been studied widely (9,10). In our opinion, based on several years experience in acute renal failure Received May 2009. Address correspondence and reprint requests to Dr Janko Kovac ˇ, Klinic ˇni oddelek za nefrologijo, Univerzitetni klinic ˇni center Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia. Email: janko.kovac@kclj.si Therapeutic Apheresis and Dialysis 13(4):350–353 doi: 10.1111/j.1744-9987.2009.00738.x © 2009 The Authors Journal compilation © 2009 International Society for Apheresis 350