Complications Related to Subclavian Catheters for Hemodialysis

Abstract

Personal experience with subclavian vein cannulations for hemodialysis are given, and the pertinent literature on the subject is reviewed. Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Immediate complications were two pneumothoraxes and two hemothoraxes due to subclavian artery puncture. Seventeen cases of bacteremia were related to subclavian catheter infections. In 1 case, a complication of sepsis was a vertebral osteomyelitis. Clinical evidences of subclavian vein thrombosis occurred in 5 cases. Life-threatening complications were met in 2 cases: 1 with pericardial tamponade due to right atrium perforation and 1 with mediastinal hematoma and right hemothorax due to superior vena cava perforation. Review of the literature indicates that pneumothoraxes and/or hemothoraxes occurred in 1.7 % of the catheter insertions and that sepsis related to subclavian dialysis catheters occurred in 8.9% of the patients. As systematically investigated subclavian vein thrombosis involved at least 50% of the patients. Our 2 personal cases of life-threatening complications and 14 similar cases of the literature were analyzed: left subclavian catheters were associated with superior vena cava perforation with right hemothorax or mediastinal hematoma, while right subclavian catheters gave atrial perforation with pericardial tamponade. Death occurred in 3 of 16 cases, and emergency surgery was required in 5 of 16 cases. Taking into account all these complications, recommendations are made for the use of subclavian dialysis catheters.

Infection of Hemodialysis Catheters: Incidence and Mechanisms

“…The incidence of catheter colonization and catheterassociated infection with or without bacteremia is still very high [3][4][5][6][7][8][9], The origin of colonizing microorgan isms may possibly be related to the type of central vein catheter, the insertion and maintenance policy and whether or not catheter replacement with a guide wire is allowed [8,10].…”

Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

“…The use of ultrasound-guided technique has reduced needle access complications [5][6][7]. Potentially fatal complication of blood vessel dissection can be minimized by the use of imaging and careful operator technique [8]. …”

Persistent Left Superior Vena cava Detected by Hemodialysis Catheterization

“…Dear Sir, Central vein catheterization for hemodialysis can induce serious complications such as pneumothorax, hemothorax, arterial puncture, and malposition of the catheter in patients with chronic renal failure [1,2]. Therefore, the position of the catheter should be confirmed after insertion by chest X-ray.…”