Temporary vascular access in dialysed patients

UNLABELLED: Presently, large venous vessel cannulation is the only procedure for attaining immediate dialysis access. As another option, vascular access may be a method for guaranteeing drug administration or parenteral feeding. The aim of the following paper was to evaluate the course of central venous catheter implantation and associated complications. The study included 235 patients (120 male, 115 female) between the ages of 24 and 87 years, treated at the Nephrology Department of the Jagiellonian University in Cracow from January, 1997 to March, 2001. Choice of cannulation location was as follows: subclavian vein--113 cases; internal jugular vein--107 cases; femoral vein--15 cases. In 223 patients, implanted catheters determined temporary access for hemo-dialysis or other extracorporeal circulation, where in 12 cases they determined location for drug administration. The following complications were observed during cannulation: accidental artery puncture--20 cases; inability to implant cannulation probe and puncture location change--16; inability to localize vessel at the first attempt of puncture--12; hematoma at puncture location--8; cephalad probe misplacement--6; bleeding at puncture site--5; catheter occlusion--25; inflammation at catheter exit site--14; catheter bending--10; vessel wall adherence of catheter arterial lumen--8; catheter removal by patient--8; damage of Luer ending--5; bacteremia confirmed by bacterial culture--4 (including 2 cases of sepsis); subcutaneous emphysema--1 case. CONCLUSION: Cannulation of large venous vessels is a safe method, associated with a small number of complications (23%), where the majority are of mild character (85%). In our material, infectious complications comprised only a low percentage (7.6%) presenting with an asymptomatic or mild course.