Which venous access sites should be avoided in patients with stage 4 or 5 CKD to prevent complications?

Selecting the right venous access site for patients with stage 4 or 5 chronic kidney disease (CKD) is crucial to minimize the risk of complications. In these advanced stages of CKD, patients often require regular dialysis treatments, making it essential to preserve appropriate access points for future use.

The subclavian vein catheter, while it can provide access, has been associated with a higher risk of complications such as thrombosis and infection, especially in patients with deteriorating renal function. Additionally, the placement of a subclavian catheter can have long-term effects, complicating future access through other methods.

The peripherally inserted central catheter (PICC) is another option, but it’s also connected to higher rates of infection and thrombosis. In patients with advanced CKD, where vascular access is vital for ongoing treatment, the less preferable options become even more critical.

In contrast, arteriovenous fistulas and grafts are more stable, durable options and generally recommended for long-term use in dialysis patients. However, they take time to mature and should ideally be created well before the need for dialysis arises.

Thus, avoiding the subclavian vein catheter and PICC in patients with advanced CKD is essential to prevent complications and