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Subclavian Catheter Central Stenosis Avoid — ESENeph MCQ

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EasyHaemodialysisSubclavian Catheter Central Stenosis AvoidESENeph

A 40-year-old man on haemodialysis via a brachiocephalic fistula develops unilateral arm oedema. He had a previous subclavian catheter on the ipsilateral side 3 years ago. What is the most likely cause?

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Correct answer: D — Central venous stenosis of the subclavian or brachiocephalic vein from previous subclavian catheter placement – this is the most important reason to avoid subclavian catheters in potential dialysis patients

Subclavian vein catheterisation causes central venous stenosis in 40-50% of cases (vs <10% for internal jugular). When an AV fistula is subsequently created on the ipsilateral arm, increased venous return through a stenosed central vein causes arm/hand oedema and chest wall collateral formation. This is why UKKA and KDOQI strongly recommend AVOIDING subclavian catheters in any patient who may need future dialysis access. Internal jugular vein is the preferred site for temporary and tunnelled catheters. Treatment of established central stenosis is endovascular angioplasty with or without stenting.

Reference: UKKA 2019 – VA; KDOQI 2019 – VA Update