SUPRACLAVICULAR APPROACH TO THE SUBCLAVIAN INNOMINATE VEIN FOR LARGE-BORE CENTRAL VENOUS CATHETERS/

Infraclavicular and internal jugular catheterization are commonly used techniques for hemodialysis access, but may at times be impeded in pa tients whose anatomy makes cannulation difficult, In an effort to enla rge the spectrum of alternative access sites, we evaluated the supracl avicular approach for large-bore catheters, During an 18-month period we prospectively collected data on success rate and major and minor co mplications of the supraclavicular access for conventional dialysis ca theters as well as Dacron-cuffed tunneled devices in 175 adult patient s admitted for various extracorporeal therapies and bone marrow transp lantation. Two hundred eight large-bore catheters (99 conventional dia lysis catheters, 63 semirigid tunneled Dacron-cuffed catheters, and 46 Hickman catheters) were successfully placed in 164 patients (success rate, 93.8%), 58 (33.1%) of whom had been previously catheterized, Com plications included pneumothorax (one patient), arterial puncture (sev en patients), and puncture of the thoracic duct (two patients) without sequelae. Postinsertional chest radiographs demonstrated impressive c oaxial lie of most catheters, Catheter malpositions occurred only spor adically (1%), Difficulty of introducing the catheter via a placed she ath was rarely observed, There was no clinically significant evidence of catheter-induced venous thrombosis or stenosis, We conclude that th e supraclavicular route is an easy and safe first approach for large-b ore catheters, as well as a useful alternative to traditional puncture sites for precatheterized and anatomically problematic patients. (C) 1997 by the National Kidney Foundation, Inc.