A retrospective analysis of central vein catheterization for hemodialysis in 866 cases

Objective To explore the safe method of central vein catheterization for hemodialysis and the measures to reduce the early complications. Methods We retrospectively analyzed 866 cases using central vein catheterization for hemodialysis. Different catheterization methods were adopted, including blind catheterization, and internal jugular vein, femoral vein and external jugular vein catheterization by ultrasound localization or ultrasound guidance. Complications and the rate of successful catheterization were also evaluated. Results Central vein catheter-ization was performed for a total of 866 cases, including 617 cases of internal jugular vein catheterization, 245 cases of femoral vein catheterization, and 4 cases of external jugular vein catheterization. Of the 512 cases using blind catheterization, successful catheterization was found in 421 (82.2%) cases, local hematoma in 10 (1.9%) cases, mis- placement into arteries in 33 (6.4%) cases, nerve injury in 4 (0.8%) cases, and subcutaneous emphysema in 1 (0.2%) case. Of the 257 cases using ultrasound localization for catheterization, successful catheterization was found in 238 (92.6%) cases, hematoma in 1 (0.4%) case, and misplacement into arteries in 2 (0.8%) cases. Of the 97 cases using ultrasound guidance for catheterization, successful catheterization was found in 92 (94.8%) cases, and no complications occurred. Central vein catheterization by ultrasound localization or by ultrasound guidance was associated with a higher successful rate (P 0.001 and P 0.002, respectively, as compared with that of blind catheterization) and a lower complication rate. Conclusion Central vein catheterization for hemodialysis is a traumatic operation with risks. Corrected manipulation and vein puncture guided by ultrasound are helpful for successful catheterization and avoidance of risks and complications.