Abstract
When emergent blood access is needed in patients without arteriovenous shunt, the double lumen catherization (Femoral vein catherization: FVC) method is usually applied. However, this method is sometimes accompanied by severe complications, e.g. hematoma and infection. Therefore, instead of using the FVC method, we tried to puncture the femoral vein repeatedly in cases in which blood access was needed (Femoral vein puncture (FVP) method). Blood was returned to the forearm vein in this method. In the present study, we compared the risks and efficacies of the two methods in patients in need of emergent blood access. Fifty patients who needed emergent blood access were included in the present study. They were in relatively good condition and alert enough to remain quiet during the hemodialysis treatment. The FVC and FVP methods were used in 30 and 20 patients, respectively. The backgrounds of the two groups such as their ages, and predialysis levels of serum creatinine, blood urea nitrogen, and potassium were comparable. Blood flow rates obtained by these methods are similar (FVC 184±3.1 vs FVP 189±6.0ml/min). However, the clearance efficiency of creatinine was significantly higher in the FVP group (FVC 56.2±1.5 vs FVP 51.1±1.9%: p<0.05) probably due to the absence of partial shunt with the FVP method. It is of note that there was no complication directly linked to blood access with the FVP method while 33.3% of the patients receiving FVC (10/30) had severe complications requiring medical treatment (p<0.05: X2). Moreover, during the treatment period, the catheter had to be changed in 40% of the FVC group patients due to difficulties in obtaining proper blood flow. Based on these data, we conclude that the FVP method is safer and less expensive (a single FVP needle is much cheaper than that used for FVC) than the FVC method. The FVP method might be useful in cases requiring emergent blood access in the absence of an arteriovenous shunt.
