Use of Catheters for Vascular Access among Hemodialysis Patients: A Single Center’s Experience

AIM: Vascular access is of prime importance for patients on hemodialysis. Most of the unplanned hemodialysis sessions are performed via venous catheters in our country. In the present study, we aimed to study early complications of placement of temporary or permanent hemodialysis catheters to patients with acute and/or chronic renal failure. MATERIAL and METHOD: Patients who were admitted to our clinic between March 2008 and May 2009 due to acute renal failure with need for urgent hemodialysis; and those on a chronic hemodialysis program but with vascular access dysfunction were included in the study. All catheter implantation procedures were performed by specialized nephrologists. A total of 362 patients (164 females, 45.3%) were examined for their demographic parameters such as age, gender, weight, body mass index; the type (permanent or temporary) and the location of the catheter (femoral, jugular or subclavian veins); technique of implantation (ultrasonography guided or blind technique); primary renal disease; acute complications within the first three days such as puncture of the artery, bleeding and findings on the follow-up chest x-ray. In addition we recorded the clinic in which they were visited and whether the patients needed urgent hemodialysis or were on a chronic hemodialysis program. Data were examined with the SPSS software. RESULTS: The mean age of the patients was 60.6±15.6 years. 275 (76%) of the catheters applied were temporary whereas 87 (24%) were permanent. 225 catheters were applied to the internal jugular vein (190 to the right, 35 to the left vein), 135 were applied to the femoral vein (100 to the right, 30 to the left vein) and 7 catheters were implanted to the subclavian veins (5 to the right, 2 to the left vein). Puncture of the artery occurred in 48 patients (13.3%) during the procedure, and 8 of these patients (2.2%) had a subcutaneous hematoma. No patient had lung trauma and there was therefore no need for removal of the catheter or a surgical intervention for the complications. CONCLUSION: The internal jugular vein is the preferred location for catheter insertion as in the present study. Our low complication rate may be related to not preferring the subclavian veins unless there is an anatomic abnormality of the other major veins. Use of hemodialysis catheters are related with high complication rates, especially in the long term. Insertion of the catheters by specialized nephrologists may decrease the rate of using the subclavian veins to international standards.