[Temporary dialysis access in patients with acute renal failure. Protocols of the dialysis centers in the Piedmont and Valled'Aosta]

Abstract

Background: A retrospective study was performed using a multiple-choice questionnaire in order to analyse the normal procedures and trends regarding the insertion and management of emergency dialysis access in patients with acute renal failure in 23 Centres in Piedment and the Aosta Valley, regions in the north of Italy with about 4.5 million inhabitants.

Methods: The observation period ran from January 1996 to July 1997. A questionnaire with 19 main questions and 90 possible multiple answers sent to 22 Centres for adults and the only pediatric centre in both regions.

Results: An analysis of the results showed that the most frequently used site in these regions is the subclavian vein (37.8%), followed by the internal jugular vein (32%), the femoral site (28.8%) and peritoneal catheter (1.4%); in pediatric patients, 5% used the femoral site, 10% the subclavian vein, 20% the internal jugular vein and 65% the peritoneal catheter. In 4 centres (18.2%), nephrologists do not position any type ofd access for acute renal failure. In 50% of centres, all doctors insert femoral catheters autonomously.

Conclusions: Some choices, such as the subclavian route, are open to criticism and may perhaps be linked to customary procedures used by anesthetists and intensive care specialists. Some centres only have relative automomy for insertion, and lastly some types of catheters and techniques are not used. The peritoneal catheter has been abandoned by adult centres as an access in acute kidney failure patients.