Complications of Insertion of Double Lumen Catheter in Subclavian Vein in Patients of Renal Failure

Abstract

Introduction: The demand of long term central venous access devices has risen over the last few decades. These devices are increasingly being used for administration of antibiotics and chemotherapeutic drugs, for total parentral nutrition and providing high flow access for hemodialysis and plasmapherisis. Inadvertent arterial puncture, ateriovenous fistula, thoracic duct injury, brachial plexus injury, laceration of the subclavian vein, and air embolism are the well described complications of the central line insertion. Objective:  This study was designed to find out the frequency of complications during Central venous line insertion via sub clavian route. Methodology: This cross-sectional descriptive study was conducted at DHQ Hospital Sargodha from April 2014 to April 2015. Two hundred patients both male and female requiring hemodialysis were included in the study. All patient underwent double lumen catheterization of subclavian vein after informed consent. Results: Mean Age of the patients was 54.55 ± 10.45. 71% of the patients were female and 29% of the patients were male. Out of 200 patients subjected to double lumen catheterizations; 28 (14.0%) developed various complications related to insertion. Out of 28 patients who developed complications, in 08 (28.57%) cases complication was failure to cannulate, in 08 (28.57%) cases there was arterial puncture, in 04 (14.28%) cases catheters were mal-positioned/kincking. Hemothorax and subclavian arterio-venous fistula developed in 02 (7.14%) each. 02 (7.14%) cases had arrhythmias and death occurred in 02 (7.14%) cases.

Conclusions & Recommendations: Subclavian double lumen catheters proved to be reasonably safe, easy and a reliable way of obtaining vascular access for hemodialysis. The procedure is a short term alternative to AV fistula formation for patients requiring long term hemodialysis. It is recommended that double lumen subclavian vein catheterization should be part of post graduate training in large units where hemodialysis is available.