Alternative puncture site for implantable permanent haemodialysis catheters

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
R ApsnerW Druml

Abstract

Vascular access represents a major problem in long-term haemodialysis patients. In patients without patent internal arteriovenous fistula, the implantation of cuffed catheters to provide a temporary or permanent central venous access is often necessary. Catheterization of the subclavian vein should be avoided because of the high risk of stenosis or thrombosis. The puncture of the internal jugular vein can be impossible in cases with stenosis or thrombosis due to previous catheterization. To overcome these limitations we evaluated an alternative puncture site for implantation of permanent central venous catheters. The very low, most central jugular approach, first described by Rao et al., with the site of puncture just above the medial notch of the clavicle, was used to introduce Dacron cuffed dialysis catheters into the innominate vein in four chronic dialysis patients with impeded conventional vascular access. In all four patients puncture of the internal jugular vein using Rao's technique was successful at the first attempt. All four catheters were introduced without any problems. Even in a case with thrombosis of the internal jugular vein and the ipsilateral subclavian vein, this technique was successfully applied. No compli...Continue Reading

Citations

Aug 25, 2006·AJR. American Journal of Roentgenology·Abigail Falk
Aug 20, 2011·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·T JakimowiczJ Szmidt
Jul 25, 2017·Paediatric Anaesthesia·Kai-Ming YuanQing-Quan Lian

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