[Temporary vascular access for haemodialysis: is infection still the most important complication?]. / L'accesso vascolare temporaneo per emodialisi: e' ancora l'infezione la complicanza da temere maggiormente?

BACKGROUND: Aging in the dialitic population currently shows the problem of vascular access for haemodialysis. The use of temporary catheters for haemodialysis has increased the risk of infections. DOQI guidelines underline this problem. We think that the thrombosis of central veins is a problem as important as infection. METHODS: In the last two years we studied prospectively 310 patients. 686 catheters for haemodialysis were placed. Infection, malfunctioning of catheters and thrombosis of central veins were studied. We compared femoral catheters with jugular catheters. Finally we studied by ultrasound the jugular vessels diameter and thrombi of jugular vein. RESULTS. Fever was present in 5.55% of patients with femoral catheters and in 5.84% of the patients with jugular catheters. The malfunctioning incidence in patients with femoral catheters was 22.75% and 8.76% in patients with jugular catheters with statistic difference. Ultrasound study of jugular veins showed thrombotic incidence of internal jugular vein in 20,8% of patients. CONCLUSIONS: We think that with correct management of catheters there is no difference in the incidence of fever in patients with jugular catheters versus femoral catheters. Probably jugular catheters have better performance than femoral catheters. We need controlled studies to better understand the problem of central vein thrombosis.