[Emergency and temporary vascular access].

Abstract

The vascular access in emergency represents a basic need for every nephrologist in order to realize an extracorporeal circuit necessary to perform hemodialysis and many other derived therapies. In the eighties a progressive abandonment of the external shunt was noted with a concomitant increase of vena cava catheterization simpler to perform, especially under echographic control, and made increasingly possible by continuous technological improvements. The femoral access is utilized in about 30% of cases, especially in critically ill patients, due to easy performing procedures and few complications. Subclavian vein is abandoned as a first choice in favour of the jugular vein due to frequent and severe early complications and to thrombo-stenotic lesions observed in about 50% of catheterizations. Prevention and rapid treatment of the complications and careful management have an important role in obtaining a prolonged catheter survival. Even if, when possible, the classical arterio-venous fistula remains the ideal solution, at least in particular patient categories a jugular vein utilization as permanent access is justified.