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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2000  |  Volume : 11  |  Issue : 1  |  Page : 74-75
Temporary Vascular Access for Hemodialysis Patients


Department of Nephrology, King Hussein Medical Center, Amman, Jordan

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How to cite this article:
Haddad A, Akash N, Ghnaimat M, El-Lozi M. Temporary Vascular Access for Hemodialysis Patients. Saudi J Kidney Dis Transpl 2000;11:74-5

How to cite this URL:
Haddad A, Akash N, Ghnaimat M, El-Lozi M. Temporary Vascular Access for Hemodialysis Patients. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2019 Nov 16];11:74-5. Available from: http://www.sjkdt.org/text.asp?2000/11/1/74/36698
To the Editor:

Double lumen central venous catheters are usually used for temporary vascular access in acute renal failure when dialysis support is needed or to allow maturation of arterio­venous fistulas in patients with chronic renal failure.[1],[2] These catheters can be inserted in a variety of sites; the first described was the subclavian vein. [3] As considerable complications were encoun­tered, other routes have become more popular, namely the internal jugular and femoral veins. [4] For accurate placement, all catheters are inserted utilizing the guidewire­over insertion technique. [5]

We would like to report our local experience on this type of vascular access. One hundred large-bore double-lumen non­cuffed catheters were inserted in 66 patients with chronic renal failure and 13 with acute renal failure as temporary vascular access for hemodialysis at our institute over a three-month period.

Sites of insertion were primarily the right subclavian vein and the right internal jugular vein. Femoral vein cannulation was chosen first in emergency cases when the patient was unable to assume the supine position because of fluid overload and when the other routes could not be cannulated for different reasons. The left subclavian or internal jugular catheterization was only attempted when there were difficulties with the right side.

The mean duration of the indwelling catheters was 32.1 day for subclavian site (range from 3-60 days), 31.9 days for internal jugular site (range froml4-60 days) and 8.8 days for the femoral site (range from 3-15 days).

Immediate complications encountered were arterial puncture in five patients and unsuccessful vascular puncture in three patients, which was attributed to venous stenosis secondary to previous cathete­rizations. Multiple attempts were needed in eight patients. Fortunately, there were no serious complications such as severe bleeding, pneumothorax, hemothorax, symp­tomatic arrhythmia or puncture of thoracic duct.

The overall rate of infection was 13%. The infections were largely due to the fact that double lumen large-bore rigid dialysis catheters were used. These catheters are manipulated frequently during dialysis and provide considerable skin-catheter interface for bacterial invasion.

The development of newer less rigid catheters that could minimize catheter movement during dialysis will probably reduce catheter infection rate. [6]

We could probably have lower incidence of infection if we kept catheters for shorter periods, for example 2-3 weeks and then to change as some studies advise [7] .

Obstructed or kinked catheters were encountered in 13% of the cases. This manifested by low arterial and/or high venous pressure during dialysis. In two cases the catheter slipped out from its position spontaneously at home with no bleeding. In our study, catheter thrombosis or obstruction was due to catheter kink, since the majority of these catheters were placed into the subclavian vein. Kinking is probably due to the curved course of the catheter and to the compression between the clavicle and first rib.

The most common complication limiting the duration of double lumen catheters is infection, while thrombosis (obstruction) is the most common complication encoun­tered during the use of these catheters. [8]

We conclude that the non-cuffed double lumen large-bore central hemodialysis catheters are still valuable in the manage­ment of uremia, generally safe with minimal complications, particularly when the jugular. route is approached. They are efficient, easy to insert, durable and problem saving.

 
   References Top

1.Sznajder JI, Zveibil FR, Bitterman H,. Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch. Intern Med 1986;146:259-61.  Back to cited text no. 1    
2.Fan PY, Schwab SJ. Vascular access: concepts for the 1990s. J Am SocNephrol   Back to cited text no. 2    
3.Uldall PR, Dyck RF, Wood F. A subclavian cannula for temporary vascular access for hemodialysis or plasmapheresis. Dial Transplant  Back to cited text no. 3    
4.1979;8:963-8. Uldall PR. Subclavian cannulation is no longer necessary or justified in patients with end-stage renal failure. Semin Dial 1994;7:161-4 . Sunder   Back to cited text no. 4    
5.Plassmann-G, Muhm M, Drum W. Placement of central venous catheters by over­insertion of guidewires: low complication rate in 1527 central venous devices. Nephrol Dial Transplant 1996; 11:911-2.   Back to cited text no. 5    
6.Dahlberg PJ, Yutuc WR, Newcomer KL. Subclavian hemodialysis catheter infections. Am J Kidney Dis 1986;12:421-7.  Back to cited text no. 6    
7.Schwab SJ, Quarles LD, Middleton JP, et al. Hemodialysis associated subclavian vein stenosis. Kidney Int 1988;33:1156-9.  Back to cited text no. 7  [PUBMED]  
8.Caruana RJ, Raja RM, Zeit RM, et al. Thrombotic complications of indwelling central catheters used for chronic hemodialysis. Am J Kidney Dis 1987;9:497-501.  Back to cited text no. 8  [PUBMED]  

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Correspondence Address:
Ayman Haddad
Department of Nephrology, King Hussein Medical Center, Amman
Jordan
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PMID: 18209304

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