Which site is the main choice for CVAD placement in patients with chronic kidney disease?

The internal jugular vein is the main choice for central venous access device (CVAD) placement in patients with chronic kidney disease due to several important factors. This site offers a favorable anatomical position that allows for easier access and is less associated with complications compared to other sites. The internal jugular vein is centrally located and provides a direct route to the superior vena cava, making it ideal for effective flow rates, essential for patients requiring hemodialysis or frequent blood draws.

Moreover, the risk of pneumothorax, which can occur during subclavian vein access, is significantly lower with the internal jugular approach. This is especially important in patients with chronic kidney disease, who may often have other comorbidities and a higher risk for complications. The internal jugular vein also allows for a relatively safer inserter technique regarding the positioning of the patient, which can further minimize procedural risks.

While the subclavian vein is another potential site, it carries more risks of complications like thrombosis and pneumothorax, and may not be as accessible in patients with altered anatomy or significant subclavian vein stenosis. The femoral vein, although an option, is generally avoided for upper body access due to higher infection rates and its location