A STUDY OF CATHETERS INSERTION - RELATED COMPLICATION

Insertion of transient catheter can save the life of patients who need emergency or urgent hemodialysis. The aim of this study was to study the incidence and types of acute complications following transient catheter insertion among patients who required them in Golestan hospital nephrology department. For this purpose, 800 temporary catheters were inserted for 670 patients who need emergent or urgent hemodialysis and who had no other available routes. Most of the patients were newly diagnosed with ESRD without any vascular access. Other cases included ARF patients, kidney recipients with early transplanted kidney dysfunction, patients with drug poisoning and a few patients who were candidated for plasmaphresis or parentral nutrition. Five hundred and eighty catheters were inserted in the subclavian vein, 150 in the internal jugular and 70 in the femoral vein. Of 670 patients (400 males and 270 females, aged between 4 to 91 years, average 49), one patient died with sever hemothorax. Eleven patients developed complications with pneumothorax, two of whom were treated conservatively and the remaining underwent chest tube insertion. Two patients had massive hemoptesia who were controlled with conservative management. Arterial puncture occurred in 160 cases among whom 6 progressed hematoma necessitating drainage, others were controlled with conservative management. Ventricular arrythmia occurred in one case who was controlled by medical treatment. Sixty cases suffered from pain at the site of puncture which was controlled by analgesics. The major dangerous complications, hemothorax and pneamothorax, were more frequently observed with subclavian catheters. The findings from this study suggest that although temporary catheters can save lives, but may also cause significant morbidity and mortality. In order to reduce these acute complications, appropriate training of residents is recommended. Furthermore, catheters should be only be inserted by trained experts and internal jugular approach is the preferable route of insertion.