Do Not Use the Subclavian Vein for Central Access of Any Type in a Patient Planned for Dialysis
Michael J. Moritz MD
Catherine Marcucci MD
There are about 300,000 hemodialysis patients in the United States today, and the number is increasing by about 4% to 5% annually. The increasing incidences of diabetes mellitus and hypertension, and the relative scarcity of renal transplants (still only about 10,000 annually in the United States) mean that hemodialysis will continue to be required. For many patients who will never receive a transplant, hemodialysis must be considered a lifelong treatment. Because the critical nature of vascular access for hemodialysis is amplified by length of time on treatment, provision and maintenance of vascular access will remain one of the greatest problems in dialysis medicine.
In the most optimal situation, permanent dialysis access is placed in advance of dialysis. However, more commonly, patients present with an acute need for dialysis that requires temporary dialysis access via a percutaneous catheter. Anesthesiologists will usually be confronted with this situation as part of the intensive care management of a patient. If there is any thought that the patient may go on to require chronic dialysis, it is imperative that the temporary access not compromise the vasculature. The preferred sites for temporary access catheter placement are the internal jugular veins or the femoral veins—not the subclavian veins.