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[Complications of the subclavian vascular approach for hemodialysis]
A Bourquia1, A J Jabrane, B Ramdani
1Service de Néphrologie/Hémodialyse, CHU Ibn Rochd, Casablanca, Maroc.
Insights
Subclavian vein catheterization is effective for emergency hemodialysis, but carries risks. Septic and thrombotic complications, including bloodstream infections and vein thrombosis, are significant concerns requiring careful management.
Area of Science:
- Nephrology
- Vascular Surgery
- Infectious Diseases
Context:
- Subclavian vein catheterization is a critical procedure for patients requiring hemodialysis, particularly in acute or chronic renal failure.
- This study evaluates the safety and efficacy of subclavian vein catheterization based on a series of 164 insertions in 111 patients.
Purpose:
- To report the authors' experience with subclavian vein catheterization for hemodialysis.
- To compare their complication rates with previously published data.
- To assess the incidence of immediate and delayed complications, including infection and thrombosis.
Summary:
- 164 subclavian catheters were placed in 111 patients undergoing hemodialysis for renal failure.
- Immediate complications included pneumothorax and subclavian artery puncture.
- Significant complications involved 17 cases of septicemia (one fatal) and 5 cases of subclavian vein thrombosis.
Impact:
- Percutaneous subclavian vein catheterization is a valuable technique for urgent renal dialysis.
- Septic and thrombotic complications are frequent and serious, necessitating risk mitigation strategies.
- While infection risks can be reduced, preventing thrombosis remains a challenge.
Abstract:
The authors report their experience of subclavian vein catheterisation and compare their results with those of previously reported series. One hundred and sixty-four subclavian catheters were inserted in 111 patients, 66 with acute renal failure and 49 with chronic renal failure. The total number of hemodialysis sessions was 984. The catheters were left in situ for an average of 14.5 +/- 2 days or 19 +/- 2 patient days. The main immediate complications were pneumothorax (1 case) and subclavian artery puncture (2 cases). Seventeen catheters were complicated by septicemia with one fatal outcome. In addition, 5 cases of subclavian vein thrombosis, diagnosed clinically and confirmed by venography, were observed. Percutaneous subclavian vein catheterisation is a useful technique for emergency renal dialysis. However, septic and thrombotic complications are fairly frequent and potentially serious. Although measures can be taken to reduce the risk of infection, the prevention of thrombosis seems to be more difficult.