Subclavian Vein Cannulation for Hemodialysis

Suitability of the left internal jugular vein for CRT‐D placement in the setting of extensive venous occlusion: Case report and review of the literature

“…11 Patients with a history of subclavian catheters have close to 50% incidence of central venous occlusion compared with IJV catheters. [12][13][14][15] The pathophysiology remains unknown but several mechanisms have been proposed including Virchow's triad of endothelial injury, stasis, and hypercoagulability at the time of insertion, presence of a foreign body in the vein, and increased flow and turbulence from the creation of an AV access, which is thought to incite an inflammatory response and stimulate intimal hyperplasia. [16][17][18] In contrast to venous occlusion from ICD placement, patients with long-term ESRD requiring HD are prone to recurrent vascular thrombosis and stenosis, which contribute to significant morbidity and mortality.…”

Infections in Chronic Hemodialysis Patients

“…It was clear from the literature that the infection rate for subclavian hemodialysis catheters was inversely related to the quality of post-insertion catheter care. This underscores the iatrogenic origin of most of these infections (33,34,37,38). Surgical insertion of Hickman dialysis catheters into the internal jugular vein through a subcutaneous tunnel was associated with a lower rate of infections than the percutaneous insertion of subclavian vein catheters (39).…”

“…That foreign material with frequent manipulations predisposes to infections is also illustrated by the infection rate observed with temporary vascular access obtained by central vein catheterization. When dialysis subclavian vein catheters were systematically cultured after removal, infection of the catheter was documented an average of 20.4% of the time (33)(34)(35)(36)(37). When infected, the catheters were the source of a bacteriemia in about 50% of the cases (33).…”

“…When dialysis subclavian vein catheters were systematically cultured after removal, infection of the catheter was documented an average of 20.4% of the time (33)(34)(35)(36)(37). When infected, the catheters were the source of a bacteriemia in about 50% of the cases (33). Bacteremia occurred in 9.9% of the patients, 6.1 % of the catheters, and at a rate of 0.43 per 100 catheter-days (cumulative data of different series reviewed in Ref.…”

“…Bacteremia occurred in 9.9% of the patients, 6.1 % of the catheters, and at a rate of 0.43 per 100 catheter-days (cumulative data of different series reviewed in Ref. 33).…”