COMPLICATIONS ASSOCIATED WITH INSERTION OF JUGULAR VENOUS CATHETERS FOR HEMODIALYSIS - THE VALUE OF POSTPROCEDURAL RADIOGRAPH

It is routine in hemodialysis units to require a chest radiograph afte r the insertion of an internal jugular line for venous access before d ialysis is commenced, There are two principal reasons for this: (1) to ensure that no procedural complications have occurred and (2) to veri fy correct catheter placement, Knowledge of the time delay involved ma y prompt nephrologists to opt for femoral access (with increased hemod ialysis recirculation and need for repeated line placement). The benef it of the postprocedural chest radiograph has never been evaluated in the hemodialysis population, We retrospectively reviewed the data on i nternal jugular access placement from two large nephrology training ce nters. Over a 36-month period, 460 internal jugular dialysis catheters were placed in 312 patients, Wherever possible, 15-cm lines were used for the left internal jugular vein and 12-cm lines for the right inte rnal jugular vein. Ultrasound guidance was used in 105 cases (22.8%), There were a total of 90 (19.6%) clinical complications in 62 patients (13.5%) These consisted of carotid artery puncture (n = 35, 7.6%) and hematoma (n = 55, 12%), All of these patients had a normal post-inter nal jugular chest radiograph. Carotid artery puncture did not occur if ultrasound guidance was used, There was no case of associated pneumot horax. Of the 370 line insertions in 250 patients in whom it was belie ved clinically that no complication had occurred, the chest radiograph only showed unsuspected line malposition in four cases (1.08%), Routi ne chest radiographs rarely contribute to the diagnosis of any procedu ral complications and are of little value after internal jugular acces s placement, especially if it is believed clinically that no complicat ion occurred. (C) 1997 by the National Kidney Foundation, Inc.