Efficacy of the supraclavicular route for temporary hemodialysis access.
The percutaneous supraclavicular approach for temporary central venous hemodialysis access was successfully used in 27 of 34 cases (79%) without significant complications and was found to be a durable technique acceptable to every patient. The supraclavicular site was used from 3 to 156 days (mean, 40 days). The average catheter life was 25 days, and 13 guidewire catheter changes among eight patients were required for catheter limb thrombosis or suspected infection. Preventable kinks resulting from technical error occurred in two catheters (5%), necessitating guidewire replacement in one. A total of 41 catheters were used, and infection was documented in one (2%). Catheters were intentionally removed in 21 patients and were removed for proved infection (1) or suspected infection (5) in the remaining six patients. No new clinical evidence of central venous stenosis or thrombosis, such as arm swelling, prominent cutaneous collateral veins, or increased venous pressure at dialysis, was observed. We suggest the supraclavicular approach as the primary route for temporary central venous hemodialysis access. Continued follow-up is necessary to substantiate the initial favorable experience with the supraclavicular technique.
Jones
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Division of Vascular Surgery, Francis Scott Key Medical Center, Baltimore, Md. 21224.
Walters
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D002968:Clavicle; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D013247:Sternoclavicular Joint; D013350:Subclavian Vein