Placement of a single-lumen catheter in the right internal jugular vein to allow for 6 weeks of intravenous ceftriaxone is appropriate for this patient with severe chronic kidney disease (CKD). This strategy seeks to protect the integrity of peripheral veins. Protecting peripheral veins is an important consideration for all patients with severe CKD or end-stage kidney disease (ESKD) because adequate veins are a prerequisite for the creation of arteriovenous fistulas, which are associated with lower mortality than other forms of vascular access for hemodialysis. Because most patients will require multiple vascular accesses during the course of ESKD therapy, it is critical to protect peripheral veins even if patients already have a functional dialysis access. Small-bore single-lumen catheters placed into the internal jugular vein are less likely to impair venous drainage from the arm than subclavian catheters.

Peripherally inserted central catheter (PICC) lines have a high risk of causing permanent thrombosis or sclerosis to peripheral veins that might otherwise be useful for the creation of vascular access for hemodialysis. PICC lines should be avoided in patients with severe CKD or ESKD who are expected to require future hemodialysis.

Subclavian catheters have a high risk of causing stenosis of the subclavian veins, which can impede return of blood from the arm with arteriovenous dialysis access due to high blood flows. High venous pressure due to subclavian stenosis can lead to arm edema and failure of the arteriovenous access.

The patient's arteriovenous fistula should not be used to administer daily intravenous antibiotics. Inserting needles into a recently created fistula can damage it because the walls of the vein will not have had adequate time to “arterialize,” which usually requires at least 2 to 3 months. Dialysis vascular access sites should only be accessed by trained dialysis personnel due to the need to protect against injury and/or infection to the access site. It is also important to avoid inflating blood pressure cuffs on the arm with vascular access to avoid injury or thrombosis.