prof.gouda

4. Percentage distribution of patients (total = 134 patients)
according to their governorates (total = 11 governorate).

5. Figure 2: Percentage distribution of patients (134 patients)
according to their Egyptian cities (32 cities).
Figure 3: Percentage distribution of patients (134 patients) according to
their hemodialysis (HD) units (46 HD units).

10. Anatomy of external jugular vein

11. Anatomy of external jugular vein
#1: It is very superficial

12. Anatomy of external jugular vein
#2: It is in line with axillar vein

13. Local Anesthesia

16. 20 (15%) Ext
Jug catheters
patients

17. Percentage distribution of patients according to
the side of insertion (right/left) of the main approaches
26.10%
10.40%
12.60%
1.50%
17.20%
4.50%
1.50%
6%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
External iliac
approach
External jugular
approach
Low IJV approach Femoral vein
approach
Right side
Left side

20. • EJV approach needs no US Doppler guided insertion in most
cases.
• It is safe as IJV approach.
• It can be used as a lifesaving approach in patients with limited
venous access.
• EJV minimal diameter of 5 mm is requested for insertion of
cuffed HD catheter.
• Create a tunnel for catheter to avoid severe bleeding on
catheter removal.
• Ipsilateral shoulder joint elevation helps in directing the guide
wire away from axillary vein to SCV during insertion of the
catheter.
Home Message
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25. ''My Access,
My Life''

26. THANK YOU
''Fistula First,
Catheter Last''
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