Abstract
Objective:To compare hemodialysis (HD) internal jugular vein (IJV) versus subclavian vein (SCV) catheters in terms of procedural complications, patients’ comfort, tolerance and cost effectiveness.Methods:Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications (CRCs) was computerized. Similarly, patients’ uncomfortability and expenditures on management of CRCs were recorded.Results:Of 66 cases, 62 (93.9%, 31/group) successfully completed the study. Baseline information showed male predominance (n = 47, 75.8%), age (M = 47, range 24-75 years) or catheter stay time (M = 40 days). The rate of vein damage or artery puncture was found higher in IJV than SCV group [(13.9 vs. 6.5%) or (9.7 vs. 3.2%), respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection (32.3 vs. 16.1%), or device dysfunctioning (9.7 vs. 3.2%) with an exception of mechanical kinking. All the patients of IJV or SCV group with missed (19.4 vs. 6.5%) or shortened HD sessions (22.6 vs. 12.9%) reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management.Conclusion:SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients’ feel comfortable and it is also cost-effective.than IJV.
Highlights
A remarkable reduction in the excretory function of the human kidney can be observed on chronic kidney disease[1] (CKD) called renal failure
Pak J Med Sci January - February 2019 Vol 35 No 1 www.pjms.org.pk 124 tunneled cuffed central venous catheter (CVC) at suitable vessel e.g. internal jugular 3 or subclavian vein is the 1st step towards efficient extracorporeal blood flow for hemofiltration
Others switched from peritoneal dialysis to HD, or on replacement of dysfunctional central venous access i.e. AV fistula/graft
Summary
A remarkable reduction in the excretory function of the human kidney can be observed on chronic kidney disease[1] (CKD) called renal failure. Waste substances accumulate in the plasma and cause certain complications like pulmonary edema-the predictor for premature death. Pakistan is a country where mortality rate on kidney diseases (majorly CKD) has touched a frightening figure of 13.5/100, 000 population.[2]. Hemodialysis (HD) is recommended as renal replacement therapy to sustain the life of the sufferer with low grade morbidity. Pak J Med Sci January - February 2019 Vol 35 No 1 www.pjms.org.pk 124 tunneled cuffed central venous catheter (CVC) at suitable vessel e.g. internal jugular 3 or subclavian vein is the 1st step towards efficient extracorporeal blood flow for hemofiltration. The device acts as a bridge while switching from one type of permanent vascular access e.g. arteriovenous (AV) fistula to other type ‘AV graft 4’on dysfunctioning
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