Abstract
Aims. Vascular access is of prime importance for hemodialysis patients. We aimed to study early complications of hemodialysis catheters placed in different central veins in patients with acute or chronic renal failure with or without ultrasound (US ) guidance. Material and Methods. Patients who were admitted to our unit between March 2008 and December 2010 with need for vascular access have been included. 908 patients were examined for their demographic parameters, primary renal disease, and indication for catheterization, type and location of the catheter, implantation technique, and acute complications. Results. The mean age of the patients was 60.6 ± 16.0 years. 643 (70.8 %) of the catheters were temporary while 265 (29.2%) were permanent. 684 catheters were inserted to internal jugular veins, 213 to femoral, and 11 to subclavian veins. Arterial puncture occurred in 88 (9.7%) among which 13 had resultant subcutaneous hematoma. No patient had lung trauma and there had been no need for removal of the catheter or a surgical intervention for complications. US guidance in jugular vein and experience of operator decreased arterial puncture rate. Conclusion. US-guided replacement of catheter to internal jugular vein would decrease complication rate. Referral to invasive nephrologists may decrease use of subclavian vein. Experience improves complication rates even under US guidance.
Highlights
Vascular access has prime importance in patients on hemodialysis (HD)
Autogenous arteriovenous fistulas (AVFs) are the first choice as the permanent vascular access, a period of at least six weeks is recommended to pass after the formation of AVF to be used [1, 2]
Prosthetic arteriovenous (AV) grafts can be cannulated within 2-3 weeks from the implantation, they are not preferred as the primary vascular access
Summary
Vascular access has prime importance in patients on hemodialysis (HD). Currently, dialysis population consists of older patients who have diabetes mellitus and peripheral obstructive vascular disease. Prosthetic arteriovenous (AV) grafts can be cannulated within 2-3 weeks from the implantation, they are not preferred as the primary vascular access. Temporary and permanent cuffed tunneled catheters should be used in these patients and those who need acute HD [5, 6]. Tunneled catheters have decreased the rates of malfunction, infection, and thrombosis significantly when compared to temporary catheters, and should be preferred if the patient would need this access for more than 1 month [7]. Placements of central venous catheters are high risk vascular procedures and require strict aseptic conditions. HD catheters are associated with higher risks of long-term complications like central venous stenosis, thrombosis, and infections, and early interventional complications like arterial puncture, haematoma, and pneumothorax
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