Vascular access for acute dialysis is accomplished by percutaneous insertion of a double-lumen catheter in the femoral, subclavian, or jugular vein ( Fig 2). The choice of site is often dictated by the underlying disease (risk of pneumothorax in respiratory compromised patients, 'traffic jam' in the superior vena cava because of the need for invasive monitoring with a pulmonary artery catheter and administration of drugs and nutrition via a triple-lumen catheter, contaminated abdominal wounds, etc.).
Compared with the internal jugular vein, cannulation of the subclavian vein is associated with more acute complications (pneumothorax, hemothorax) as well as an increased incidence of late stenosis. Femoral catheters carry an increased infection risk and limit the patient's mobility. Scribner shunts provide a lower blood flow and have an increased risk of clotting.
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