Internal jugular and subclavian catheterisation: indications, problems and prospects in a Nigerian dialysis centre

To highlight the indications, problems and prospects of bedside non-surgically inserted jugular and subclavian dual lumen catheters.

Renal failure patients being managed in our centre with indications for central catheterisation were consecutively recruited at presentation. They had bedside non-surgical jugular and subclavian insertion of central catheters using modified Seldinger wire technique and the performance of the catheters monitored.

Sixteen patients aged between 23 and 65 years had 32 central catheterizations during the 12-month period. The indications included its use as haemodialysis access in all catheterisations, additional indications were CVP monitoring in 5, and parenteral hyperalimentation in 1. Three catheterisations were in right subclavian vein, 4 in left internal jugular vein and 25 in right internal jugular vein. The duration of use ranged between 3 days and 11 weeks and blood flow rate used ranged between 250 and 350 mls/min. Nine (28.1%) catheterisations were complicated with exit site and systemic infection. Catheter blockage and accidental catheter removal were recorded in 3 patients each. Carotid artery puncture was recorded in 2 patients but haemostasis was maintained with direct digital compression.

We conclude that percutaneous bedside internal jugular and subclavian (venous) catheterisation using dual lumen catheter is safe and devoid of major complications.