An alternative approach to the central circulation from above the diaphragm.

This is a review of a new fluoroscopically guided safe technique to place tunneled cuffed hemodialysis (HD) catheters via the supraclavicular location. Right supraclavicular catheters were placed in 12 patients who had no patent internal jugular veins. The placements were all successful and without serious complications. Over the 2 years of follow-up, two episodes of thrombosis/stenosis (16.7%) resulted in catheter removal. The rate of infection was 8%, or one episode in 1204 patient-days. The average length of use was 111 days. The average rate of blood flow was 354 cc/min. The right supraclavicular approach for tunneled HD catheters is safe and compares favorably to the internal jugular approach for patients with limited access options.