Korean Journal of Nephrology 1991;10(3):372-378.

혈액투석을 위한 쇄골하정맥 카테터의 합병증에 관한 연구

신영태 , 신승훈 , 정민수 , 이순구 , 이정호 , 이강욱

Abstract

We reviewed our experience with subclavian vein catheter as temporary vascular access for hemodialysis from July 1986 to June 1990. For a total of 1188 hemodialysis session in 82 patients (ARF: 12 patients, CRF: 70 patients), 149 subcalvian catheters were inserted and kept for a total of 2958 days. The single lumen catheter was implanted infra- clavicularly by Seldinger thechnique. The average num- ber of the cannulation was 1.8 per patien t, and the catheter were left in for a mean of 19.9 days per catheter and 36.1 days per patient. The average dialysis session were 14.5 per patient and 8.0 per catheter. The average interval between dialysis session was 2.5 days. Acute and chronic complications were recorded in 30 (36.6%) of 82 patients and 58 cases (38.9%) of 149 cath- eters. There was no mortality case due to these com- plications. The acute complications occurred in 9 cases (6.1%) Of 149 catheter' insertion; malposition of catheter (5 cases), bleeding (1 case), hemopneumothorax (1 case) and pneumothorax (1 case). The chronic complications occurred in 49 cases (33.8%) of 145 catheterization; inadequate blood flow or obstruc- tion (23 cases), catheter related infection (15 cases), dislocation of catheter (9 case) and catheter injury (2 cases). Infection related to subclavian dialysis catheters oc- curred in 14.6% of patients and 10.3% of catheters. The culture proven microorganisms were Staphylococcus aureus in 5 cases (71.4%), Staphylococcus epidermidis and E coli in each one case. The patients age, duration of cannulation periods, hemodialysis number per cath- eter, and interval of hemodialysis were not different significantly between infected and noninfected group of patients. The results indicate that subclavian vein catheteriza- tion is a safe and convinient method as rapid vascular accessment for hemodialysis, but requires skillful oper- aters and meticulous postinsertion care in order to reduce complications.