Subclavian vein dialysis access catheter-complications are low.

Internal jugular vein has been recommended as the vascular access for haemodialysis because it is associated with less thrombotic/stenotic complication. Despite this recommendation, subclavian vein access is still being frequently used. This paper aims at reviewing the rate of complications associated with temporary double lumen subclavian vein dialysis access catheter in a personal series. It is a prospective observational study. Patients undergoing haemodialysis through a temporary double lumen subclavian catheter, all inserted by author, in the haemodialysis unit of B and B Hospital, have been included. Catheters inserted into the internal jugular vein or femoral vein have been excluded. Catheter was inserted by Seldinger technique and a chest Xray was routinely obtained after the insertion. Patients were observed and followed up prospectively for the possible mechanical, infective and thrombotic complications at the time of catheter insertion and into each subsequent dialysis visit that ranged from 2 weeks to four and half months when the catheter was removed or replaced by native arteriovenous fistula. During the last five and half year (Jan 2004 to July 2009), a total of 203 suvclavian vein catheters were inserted into 105 males and 98 females. The mean age was 53 years (range from 18 to 80 years) and most of the patients had catheters for chronic renal failure (95.0%). Insertion related complications in the form of arterial puncture (3.0%), inability to cannulate on the right side (2.0%) and both right and left side (1.0%), malposition (3.0%), pneumothorax (0.5%) and accidental removal of catheter (0.5%) were noted. Similarly, 6.0% catheter related infection, 2.0% thrombosis/stenosis and 6.0% catheter malfunction were observed. Fortunately, there was no catheter related mortality. These complications appear quite low and well comparable to internal jugular vein access as reported in the literature. The most quoted evidence of symptomatic subclavian vein thrombosis/stenosis is lower in Nepalese patients. Hence, subclavian vein access may be recommended as a safe alternative access for haemodialysis.

Dialysis access pattern in incident haemodialysis patients at B & B Hospital, Kathmandu, Nepal.

The clinical practice guideline for vascular access in haemodialysis recommends the use of arteriovenous fistula (AVF) over a central venous catheter. AVF needs to be created sufficiently in advance of anticipated haemodialysis. However, many incident haemodialysis patients are still being dialyzed with central venous catheter at the time of first haemodialysis. This paper aims at presenting the pattern of dialysis vascular access in incident haemodialysis patients at our institution from July 2002 to July 2008 in a cohort of patients who were referred to us for creation of native AVF. A total of 100 patients (56 male and 44 female) with the mean age of 54 years were studied. Only 110.0% of patients were found to have AVF created in advance and the rest (89.0%) were dialyzed via central venous catheter. Of the 11 patients with AVF; 5 fistulas were created 3 months prior to the dialysis, 3 fistulas between 1 and 3 months prior and 3 less than a month of anticipated dialysis. Interestingly, 35.0% of total patients were seen by nephrologists only a month prior to the dialysis. Hence, an early referral of the chronic renal failure patients to the nephrologists and vascular access surgeons may overcome this problem.