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Large vein cannulation for hemodialysis was used in 1164 patients undergoing dialysis treatment and in a n acute dialysis program. Subclavian vein cannulation was utilized in 2494 dialyses, and femoral vein cannulation was used in 2368 dialyses. No significant differences with regard to clinical complications were encountered in either type of cannulation. The mortality rate due to subclavian vein cannulation was 0.12%, while that due to femoral vein cannulation was 0.04%. The main risk of subclavian vein cannulation was arterial bleeding, due to trauma to a n artery, and pneumothorax, more likely occurring in asthenic patients or in patients with emphysema. Single-needle hemodialysis using subclavian or femoral vein cannulation gave the same results as the arteriovenous Cimino fistula. Intermittent or combined use of both types of large vein cannulation is advantageous in long-term regular dialysis patients that are waiting for a new fistula.cannulation, subclavian vein cannulation, femoral vein cannulation, arteriovenous fistula, hemodialysis, single-needle hemodialysis, pneumothorax MATERIALS AND METHODSTwo polyethylene cannulas measuring 15 to 20 cm (PE 204 or Kifa yellow catheter, Siemens-Elerna, Solna, Sweden) with three or five terminal and lateral apertures a t the tip, provided with a 3-cm-long connection with blood sets for hemodialysis, are introduced percutaneously into the same subclavian or femoral vein. The distance between the two tips should be a t least 1 cm to avoid the risk of a shunt due to high blood flow rate through these large veins. Details of the technique were previously described.'-'In subclavian vein cannulation, all patients were cannulated by the supraclavicular or infraclavicular route using a 7-cm-long needle. The direction of the needle (Fig. 2) is determined by a line connecting two points: one point is midway between the acromion and the anterior axillary fold, and the other lies on the upper margin of the sternoclavicular joint. The needle is inserted a t a n angle of 15" from the frontal plane, with the tip directed backward. With the supraclavicular route, the needle is inserted in the angle between the upper border of the clavicle and the lateral margin of the sternocleidomastoid muscle at 45" from the sagittal and transverse

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On the basis of direct quantification of hemodialysis (HD), the kinetics of phenols (Ph) were followed in 13 patients on regular HD treatment. The average plasma levels of Ph before and after HD were 627 +/- 109 mumol/L and 416 +/- 81 mumol/L, respectively. The total amount of Ph removed during 5-h HD was 7,481 +/- 1,894 mumol. For calculation of the generation rate (G), a new formula has been derived not requiring knowledge of the corresponding volume of distribution. The G of Ph was 2.9 +/- 0.7 mumol/min on average. The mean dialysis clearance (K) of Ph was 48.2 +/- 10.2 ml/min.