Complications related to subclavian catheters for hemodialysis. Report and review

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Bronchopulmonary superinfections in the critically ill.

Bacterial colonization of the airways can lead to nosocomial respiratory infections. The emergence of Gram-negative bacteria in the upper airways is usual in critical conditions. Antimicrobial therapy and especially bacterial adherence to the airways mucosa have been incriminated in the selection of Gram-negative bacteria becoming ultimately multiresistant. Transmission of bacteria by the hands of the ICU-personnel and aspiration of bacteria represent two important factors in the airway colonization. Bacterial clearance can simultaneously be impaired by debility and altered mental state. Pulmonary infections are especially common in peritonitis or after abdominal surgery. In a series of 30 patients who had a complicated course after abdominal surgery, we observed that in all patients with acute respiratory failure, sputum cultus yielded at least one microorganism also recovered from cultus of the abdominal secretions. Acute respiratory failure was most commonly due to respiratory infection and carried a worse prognosis. Aspiration of bacteria from the gastrointestinal tract appears to represent the most common source of nosocomial bronchopulmonary superinfection in the critically ill.Journal Articleinfo:eu-repo/semantics/publishe

Complications related to subcalvian catheters for hemodialysis: report and review

Personal experience with subclavian vein cannulations for hemodialysis are given, and the pertinent literature on the subject is reviewed. Two hundred subclavian dialysis catheters were placed in 148 patients who kept them in place for a total of 2,798 days. Immediate complications were two pneumothoraxes and two hemothoraxes due to subclavian artery puncture. Seventeen cases of bacteremia were related to subclavian catheter infections. In 1 case, a complication of sepsis was a vertebral osteomyelitis. Clinical evidences of subclavian vein thrombosis occurred in 5 cases. Life-threatening complications were met in 2 cases: 1 with pericardial tamponade due to right atrium perforation and 1 with mediastinal hematoma and right hemothorax due to superior vena cava perforation. Review of the literature indicates that pneumothoraxes and/or hemothoraxes occurred in 1.7% of the catheter insertions and that sepsis related to subclavian dialysis catheters occurred in 8.9% of the patients. As systematically investigated subclavian vein thrombosis involved at least 50% of the patients. Our 2 personal cases of life-threatening complications and 14 similar cases of the literature were analyzed: left subclavian catheters were associated with superior vena cava perforation with right hemothorax or mediastinal hematoma, while right subclavian catheters gave atrial perforation with pericardial tamponade. Death occurred in 3 of 16 cases, and emergency surgery was required in 5 of 16 cases. Taking into account all these complications, recommendations are made for the use of subclavian dialysis catheters.Case ReportsJournal Articleinfo:eu-repo/semantics/publishe