Use of large-bore catheters in the internal jugular vein as an access route for emergency hemodialysis.

Our experience with catheterization, mainly of the internal jugular vein, using a large-bore catheter (Shaldon catheter) with 279 patients and a total of 359 catheter placements, is reported. The subclavian vein was used for vascular access in 57 additional patients (80 catheters) and the femoral vein in four patients (six catheters). Percutaneous puncture of the jugular, subclavian and femoral veins in a total of 340 patients (445 catheters) was necessary for emergency hemodialysis, hemofiltration, hemoperfusion, plasmapheresis or, in the case of patients on regular hemodialysis, for temporary vascular access while awaiting the availability of another access site. Complications were less frequent with the internal jugular point of entry than with others, based on our experience and the literature published. Cannulation of the superior vena cava through the internal jugular vein therefore appears to be a most appropriate route for rapid vascular access when emergency extracorporeal blood treatment is required.