In patients with stage 4 or 5 CKD, which access site should be avoided to minimize venous stenosis and thrombosis risk?

The subclavian vein catheter is recognized for its increased risk of venous stenosis and thrombosis, particularly in patients with stage 4 or 5 chronic kidney disease (CKD). This is primarily due to the anatomical and physiological changes that occur in these patients, such as alterations in blood flow dynamics and vascular health.

Inserting a catheter into the subclavian vein can lead to a mechanical compression of the vein and subsequent development of thrombosis. Additionally, repeated catheterization of this area may exacerbate stenosis, which compromises future vascular access options. In patients with advanced kidney disease, maintaining good venous access for dialysis is crucial, making it essential to avoid sites that pose higher risks for complications like stenosis and thrombosis.

In contrast, arteriovenous fistulas and grafts are commonly used dialysis access options that are designed to improve long-term access and have a lower risk of complication when appropriately placed and cared for. Peripherally inserted central catheters also carry risks, but they are generally less associated with the same degree of stenosis as subclavian catheters. Thus, avoiding the subclavian vein in this context is essential for optimizing vascular access in patients with severe CKD.