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Aim Internal jugular vein (IJV) catheterization is often required to gain access for haemodialysis. Use of ultrasound guidance has reduced the complication rates of this procedure. We hypothesized that nephrologists may perform IJV cannulation with a high technical success and low immediate complication rates under real-time ultrasound guidance. Methods We prospectively analyzed 323 patients (186 male, 137 female) who underwent IJV cannulation with real-time ultrasound guidance. The number of needle punctures, technical success, the time between injection of local anaesthetic and entry into the IJV, and immediate complications were recorded. Patients with a history of multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk group. Results Cannulation of IJV was achieved in all patients. Of the 323 catheters, 125 (38.7%) were placed in high-risk patients. Average number of puncture was 1.26 (range, 1-4). IJV was entered on the first attempt in 261 (80.8%) patients. Only ten complications (10/323, 3.2%) developed; five (2.5%) in the normal-risk group, and five (4.0%) in the high-risk group. Cannulation of IJV took a longer time in the high-risk group than in the normal-risk group. The number of needle punctures, percent of successful cannulation on the first attempt, and the frequency of complications were similar between the high- and normal-risk groups. Conclusions Cannulation of IJV under real-time ultrasound guidance is very safe with high technical success rates. Nephrologists can use this technique with ease and with minimal complications in normal- and high-risk patients.

Cardiovascular diseases are the leading causes of mortality in hemodialysis patients. Uremia induced hypertriglyceridemia; increased levels of lipoprotein remnants and low high-density lipoprotein are the main features of cardiovascular risk factors. Also, elevated oxidative stress and inflammation are the main contributors of endothelial dysfunction. Even statin based interventional trials failed to improve mortality in dialysis patients, and different treatment options have been proved to be useful. We aimed to evaluate the effect of dialyzer type on uremia-associated dyslipidemia and endothelial dysfunction. In total 312 patients were enrolled. The initial and 6(th) month blood samples were obtained from the non-arteriovenous fistula arm on the day before the first hemodialysis session of the week. Flow mediated dilatation of the patients was measured from the same arm before obtaining the blood samples. Patients were on hemodialysis therapy for 76.43 ± 52.7 months. According to their dialyzer type, there has been a statistically significant improvement noted in terms of total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and triglyceride levels. The flow mediated dilatation of the patients are measured as 4.3 ± 0.5 and 4.4 ± 0.4 in baseline measurements of the low flux and high flux groups, respectively. Sixth month values of the patients were measured as 4.34 ± 0.4 and 4.62 ± 0.6. The improvement in low flux groups was not statistically significant but in the high flux group the endothelial dysfunction was significantly improved. Our results show that high-flux dialyzers improved dyslipidemia and endothelial dysfunction in hemodialysis patients. These findings provide a new insight on the selection of high efflux in hemodialysis.