ABSTRACT
Objective: To compare hemodialysis [HD] internal jugular vein [IJV] versus subclavian vein [SCV] catheters in terms of procedural complications, patients' comfort, tolerance and cost effectiveness
Methods: Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications [CRCs] was computerized. Similarly, patients' uncomfortability and expenditures on management of CRCs were recorded
Results: Of 66 cases, 62 [93.9%, 31/group] successfully completed the study. Baseline information showed male predominance [n = 47, 75.8%], age [M = 47, range 24-75 years] or catheter stay time [M = 40 days]. The rate of vein damage or artery puncture was found higher in IJV than SCV group [[13.9 vs. 6.5%] or [9.7 vs. 3.2%], respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection [32.3 vs. 16.1%], or device dysfunctioning [9.7 vs. 3.2%] with an exception of mechanical kinking. All the patients of IJV or SCV group with missed [19.4 vs. 6.5%] or shortened HD sessions [22.6 vs. 12.9%] reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management
Conclusion: SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients' feel comfortable and it is also cost-effective.than IJV