SP536ACUTE AND CHRONIC COMPLICATIONS UPON APPLYING TEMPORARY CATHETERS: PLACE OF INSERTION DEPENDENCE

Abstract

Introduction and Aims: The vascular access for hemodialysis patients continues to be a critical problem within the contemporary dialysis era. The aim of this study is to show acute and chronic complications observed on temporary catheters inserted into femoral veins, internal jugular vein, and the subclavian vein using the infra- and the supra-clavicular approaches. Methods: We provide our experience on insertion of 506 temporary catheters within a five-year period (as of January 1, 2010 through December 31, 2014). The collected data includes age, sex, reasons for hemodialysis, eight different sites of central vein cannulations, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion place. Almost all procedures are executed by one nephrologist who has experience of >; 200 insertions of temporary and tunneled catheters per year. Results: The gender distribution shows 224 (44 %) women and 282 (56 %) men. The median women age was 59.8 (+/- 13.2) years, and the median men age was 58.7 (+/- 13.7) years. The target vein was successfully cannulated at first or second attempt in 94 % of the cases. The number of attempted catheterizations is a predictor for the relative share of acute complications (p = 0.0001, r = 0.46). We found AC in 8 cases (1.6 %), of which 6 cases (1.2%) are arterial lesions (AL) and 2 cases (0.4%) are catheters malposition (Malp.). AL on the femoral vein (FV) cannulation is found in 67 % of the cases, all cases of Malp. are in the left subclavian vein. We calculated chronic complications in 311 patients, with chronic renal failure found in 23% of cases, 16.5 % - thrombotic complications, 5.1 % - catheter-related infections (CRI) and in 1.6 % - stenosis of central vein. The period between the insertion and the appearance of complications is significant ( p<0.05) - 14 days for thrombosis, 15 - for CRI and 22 days for stenosis. Primary catheter patency is 17-15 days for FV, 21-33 days for subclavian vein (infraclavicular approach), 26 - 33 for internal jugular vein and 35 - 47 days for subclavian vein (supraclavicular approach) for right and left site, respectively; differences are significants ( p<0.05). Conclusions: We conclude that the cannulation of the central vein for hemodialysis can be successfully executed by nephrologists. Most complications are FV cannulations. The operator's sufficient proficiency is a guarantee for relatively small share of non-fatal complications and the supraclavicular approach to the subclavian vein is a good alternative.