Delayed life threatening complications after insertion of dialysis catheters

Sir, In the teaching point section of NDT, J.A. Kielstein et al. w1x reported on a haemothorax occurring on the seventh dialysis session after the patient was given a left internal jugular catheter for dialysis. The six preceding dialysis sessions were without problems. The haemothorax was related to a perforation of the brachiocephalic vein. In their discussion, J.A. Kielstein et al. state that ‘such a late onset complication has not previously been reported’ and they support their statement by a reference to one of my papers w2x. The paper they cite deals with the complications of subclavian catheters and mentions, in fact, perforation occurring often 2 to 26 dialysis sessions after the insertion of the catheters. In all these cases, the catheter placed by left subclavian route had caused right-sided perforation of the superior vena cava w2x.