Hemodialysis is important part of management in patients with severe metabolic acidosis and hyperkalemia. Central venous insertion of dialysis catheter in femoral vein and internal jugular vein is commonly performed. Efficacy of dialysis depends on proper inflow and outflow of blood through dialysis catheter. Inadequate free flow in one port of dialysis catheter does not always mean blockage of the catheter. We need to know anatomical course of the vein to understand the mechanism of inadequate flow.
58 year old lady was admitted in intensive care unit with cardiogenic shock and severe metabolic acidosis. In view of anuria and progressive acidosis, it was decided to perform hemodialysis. Under all aseptic precautions, left femoral vein was punctured and double lumen dialysis catheter was inserted. Back flow could be easily aspirated in one lumen but not in other; however saline was easily flushed in through both lumens without resistance. As the dialysis machine inflow and outflow tubes were connected to the two ports of catheter, blood could not be aspirated through outflow tube.