Complications and Side Effects Associated with Large‐Bore Catheters in the Subclavian and Internal Jugular Veins

Abstract

Since the introduction of large-bore catheters for acute hemodialysis 30 years ago, many problems with handling, material, and contamination of these catheters exist. Nevertheless, catheterization of the inferior and superior vena cava with a large-bore catheter has proved to be suitable as a rapid connection process for hemodialysis, hemofiltration, hemoperfusion, plasmapheresis, plasmaperfusion, among others. In a retrospective study with 2,741 large-bore catheters in 1,716 patients, the frequency of infections, thrombosis, bleeding, and other side effects was investigated. All complications and side effects are presented dependent on vascular access route. In total, the complication rate was 48.9% higher in subclavian puncture than in internal jugular puncture (24.8%). The highest complication rates for both vascular access routes were infections or septicemia; infections were observed in 19.5% of subclavian catheters versus 10% of internal jugular catheters.

Brachio-cephalic ('Gracz') fistula use for continuous hemofiltration in a hemodynamically unstable hemodialysis patient without venous vascular access: a case report

“…Moreover, heparine given by the dialysis line may produce a higher local (femoral vein) heparine concentration with concurrent improved prevention of femoral/iliac vein thrombosis when compared to subcutaneous application of low molecular weight heparin analogues. Besides side-effects related to central venous catheters [6], obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic, especially in the child or adult in multiple organ failure with edema and/or coagulopathy [7]. Ultrasound guidance for cannulation of the internal jugular and subclavian veins may be used.…”

Renal replacement therapy in the intensive care unit

“…These may be inserted in the internal jugular, subclavian, or femoral veins. If possible, subclavian vein cannulation should be avoided because of a high incidence of subsequent venous stenosis, which may significantly complicate venous access if chronic hemodialysis is required (Stalter et al 1986; Cimochowski et al 1990; Bambauer et al 1994). Blood recirculation from the venous to the arterial port can reduce the effectiveness of dialytic therapies, particularly during IHD.…”

Cyclosporine and Therapeutic Plasma Exchange in Treatment of Progressive Autoimmune Diseases

“…The first TPE treatments were effected using the single needle technique over large bore catheters placed in the superior vena cava or the jugular veins (22,23). Periodic treatment was effected via peripheral vascu- 1 31 lar access points using the double needle technique.…”

“…Following a series of 7-16 (9.4 * 2.3) TPE treatmentdpatient at 2 to 3 day intervals at the onset of the trial, additional TPE sessions were carried out depending on the symptomatology. The first TPE treatments were effected using the single needle technique over large bore catheters placed in the superior vena cava or the jugular veins (22,23). Periodic treatment was effected via peripheral vascu- lar access points using the double needle technique.…”