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Central catheters for acute and chronic hemodialysis access

Steven J Bander, MD
Steve J Schwab, MD
Karen Woo, MD
Section Editors
David L Cull, MD
Jeffrey S Berns, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. Immediate hemodialysis access should be straightforward, available for immediate use, and have minimal complications in the short term (days to weeks). A large-bore double-lumen nontunneled catheter is most often used when an immediate need for hemodialysis arises (eg, acute kidney injury, thrombosed hemodialysis access, poisoning). If dialysis for more than one week or so is likely, a cuffed, tunneled catheter should be used instead. Cuffed, tunneled catheters can also be placed for patients with chronic kidney disease who require dialysis but do not have a functional permanent vascular access. Ideally, when permanent dialysis access is required, an arteriovenous hemodialysis fistula is created or a prosthetic arteriovenous graft is placed. Once the fistula or graft can be used reliably, the catheter is removed. (See "Maturation and evaluation of the newly created hemodialysis arteriovenous fistula".)

The basic aspects of dialysis access catheters and their complications will be reviewed here. An overview of central venous access and placement of catheters at specific sites is discussed elsewhere. (See "Overview of central venous access".)


The broad categories of catheters available for hemodialysis vascular access include nontunneled and tunneled catheters (figure 1). (See "Overview of central venous access", section on 'Central catheters and devices'.)

The basic principles governing the use of catheters for hemodialysis and the general features of nontunneled and tunneled catheters are discussed below. There are many types of hemodialysis catheters, but few trials are available systematically comparing the various catheters to assess the performance of different materials and catheter shapes on delivered dialyzer blood flow rates and rates of infection or thrombosis [1-3].

A multidisciplinary panel of experts formed a workgroup to develop a document proposing standardized definitions for central venous catheters endpoints (catheter-related bloodstream infections, catheter dysfunction, and central vein obstruction) to help guide future product development and clinical trials on dialysis catheters [4].

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Literature review current through: Dec 2017. | This topic last updated: Nov 20, 2017.
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  1. Oliver MJ, Edwards LJ, Treleaven DJ, et al. Randomized study of temporary hemodialysis catheters. Int J Artif Organs 2002; 25:40.
  2. Van Der Meersch H, De Bacquer D, Vandecasteele SJ, et al. Hemodialysis catheter design and catheter performance: a randomized controlled trial. Am J Kidney Dis 2014; 64:902.
  3. Power A, Hill P, Singh SK, et al. Comparison of Tesio and LifeCath twin permanent hemodialysis catheters: the VyTes randomized trial. J Vasc Access 2014; 15:108.
  4. Allon M, Brouwer-Maier DJ, Abreo K, et al. Recommended Clinical Trial End Points for Dialysis Catheters. Clin J Am Soc Nephrol 2017.
  5. Contreras G, Liu PY, Elzinga L, et al. A multicenter, prospective, randomized, comparative evaluation of dual- versus triple-lumen catheters for hemodialysis and apheresis in 485 patients. Am J Kidney Dis 2003; 42:315.
  6. Shamir MY, Bruce LJ. Central venous catheter-induced cardiac tamponade: a preventable complication. Anesth Analg 2011; 112:1280.
  7. Coryell L, Lott JP, Stavropoulos SW, et al. The case for primary placement of tunneled hemodialysis catheters in acute kidney injury. J Vasc Interv Radiol 2009; 20:1578.
  8. Ponikvar R, Buturović-Ponikvar J. Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients. Ther Apher Dial 2005; 9:250.
  9. Cheesbrough JS, Finch RG, Burden RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986; 154:579.
  10. Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant 2004; 19:670.
  11. Dugué AE, Levesque SP, Fischer MO, et al. Vascular access sites for acute renal replacement in intensive care units. Clin J Am Soc Nephrol 2012; 7:70.
  12. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48 Suppl 1:S176.
  13. Oliver MJ, Callery SM, Thorpe KE, et al. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int 2000; 58:2543.
  14. Schwab SJ, Beathard G. The hemodialysis catheter conundrum: hate living with them, but can't live without them. Kidney Int 1999; 56:1.
  15. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis 2001; 37:S137.
  16. Parienti JJ, Mégarbane B, Fischer MO, et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med 2010; 38:1118.
  17. Weijmer MC, Vervloet MG, ter Wee PM. Prospective follow-up of a novel design haemodialysis catheter; lower infection rates and improved survival. Nephrol Dial Transplant 2008; 23:977.
  18. Vesely TM, Ravenscroft A. Hemodialysis catheter tip design: observations on fluid flow and recirculation. J Vasc Access 2016; 17:29.
  19. Ash SR. Advances in tunneled central venous catheters for dialysis: design and performance. Semin Dial 2008; 21:504.
  20. Hockenhull JC, Dwan KM, Smith GW, et al. The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: a systematic review. Crit Care Med 2009; 37:702.
  21. Chatzinikolaou I, Finkel K, Hanna H, et al. Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections: a prospective, randomized study. Am J Med 2003; 115:352.
  22. Dwyer A. Surface-treated catheters--a review. Semin Dial 2008; 21:542.
  23. Trerotola SO, Johnson MS, Shah H, et al. Tunneled hemodialysis catheters: use of a silver-coated catheter for prevention of infection--a randomized study. Radiology 1998; 207:491.
  24. Alderman RL, Sugarbaker PH. Prospective nonrandomized trial of silver impregnated cuff central lines. Int Surg 2005; 90:219.
  25. Jain G, Allon M, Saddekni S, et al. Does heparin coating improve patency or reduce infection of tunneled dialysis catheters? Clin J Am Soc Nephrol 2009; 4:1787.
  26. Clark TW, Jacobs D, Charles HW, et al. Comparison of heparin-coated and conventional split-tip hemodialysis catheters. Cardiovasc Intervent Radiol 2009; 32:703.
  27. Bridges C. New heparin coating reduces thrombosis and fibrin sheath formation in HD catheters. Nephrol News Issues 2007; 21:32, 34.
  28. Hodges TC, Fillinger MF, Zwolak RM, et al. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg 1997; 26:1009.
  29. Tesio F, De Baz H, Panarello G, et al. Double catheterization of the internal jugular vein for hemodialysis: indications, techniques, and clinical results. Artif Organs 1994; 18:301.
  30. Lund GB, Trerotola SO, Scheel PF Jr, et al. Outcome of tunneled hemodialysis catheters placed by radiologists. Radiology 1996; 198:467.
  31. Mosquera DA, Gibson SP, Goldman MD. Vascular access surgery: a 2-year study and comparison with the Permcath. Nephrol Dial Transplant 1992; 7:1111.
  32. Duncan ND, Singh S, Cairns TD, et al. Tesio-Caths provide effective and safe long-term vascular access. Nephrol Dial Transplant 2004; 19:2816.
  33. Suhocki PV, Conlon PJ Jr, Knelson MH, et al. Silastic cuffed catheters for hemodialysis vascular access: thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996; 28:379.
  34. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348:1123.
  35. Fan PY, Schwab SJ. Vascular access: concepts for the 1990s. J Am Soc Nephrol 1992; 3:1.
  36. Bander, SJ, Schwab, SJ. Central venous angioaccess for hemodialysis and its complications. Semin Dial 1992; 5:121.
  37. Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates. J Vasc Interv Radiol 2013; 24:1295.
  38. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.
  39. Hernández D, Díaz F, Rufino M, et al. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J Am Soc Nephrol 1998; 9:1507.
  40. Silberzweig JE, Sacks D, Khorsandi AS, et al. Reporting standards for central venous access. J Vasc Interv Radiol 2003; 14:S443.
  41. Maya ID, Allon M. Outcomes of tunneled femoral hemodialysis catheters: comparison with internal jugular vein catheters. Kidney Int 2005; 68:2886.
  42. Little MA, Conlon PJ, Walshe JJ. Access recirculation in temporary hemodialysis catheters as measured by the saline dilution technique. Am J Kidney Dis 2000; 36:1135.
  43. Nadolski GJ, Trerotola SO, Stavropoulos SW, et al. Translumbar hemodialysis catheters in patients with limited central venous access: does patient size matter? J Vasc Interv Radiol 2013; 24:997.
  44. Herscu G, Woo K, Weaver FA, Rowe VL. Use of unconventional dialysis access in patients with no viable alternative. Ann Vasc Surg 2013; 27:332.
  45. Frampton AE, Kessaris N, Hossain M, et al. Use of the femoral artery route for placement of temporary catheters for emergency haemodialysis when all usual central venous access sites are exhausted. Nephrol Dial Transplant 2009; 24:913.
  46. George A, Tokars JI, Clutterbuck EJ, et al. Reducing dialysis associated bacteraemia, and recommendations for surveillance in the United Kingdom: prospective study. BMJ 2006; 332:1435.
  47. Wilkin TD, Kraus MA, Lane KA, Trerotola SO. Internal jugular vein thrombosis associated with hemodialysis catheters. Radiology 2003; 228:697.
  48. Geddes CC, Walbaum D, Fox JG, Mactier RA. Insertion of internal jugular temporary hemodialysis cannulae by direct ultrasound guidance--a prospective comparison of experienced and inexperienced operators. Clin Nephrol 1998; 50:320.
  49. Keenan SP. Use of ultrasound to place central lines. J Crit Care 2002; 17:126.
  50. Skolnick ML. The role of sonography in the placement and management of jugular and subclavian central venous catheters. AJR Am J Roentgenol 1994; 163:291.
  51. National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. 2005. http://www.nice.org.uk/nicemedia/live/11474/32461/32461.pdf (Accessed on December 12, 2011).
  52. Kwon TH, Kim YL, Cho DK. Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access. Nephrol Dial Transplant 1997; 12:1009.
  53. Kumwenda MJ. Two different techniques and outcomes for insertion of long-term tunnelled haemodialysis catheters. Nephrol Dial Transplant 1997; 12:1013.
  54. Lin BS, Huang TP, Tang GJ, et al. Ultrasound-guided cannulation of the internal jugular vein for dialysis vascular access in uremic patients. Nephron 1998; 78:423.
  55. Prabhu MV, Juneja D, Gopal PB, et al. Ultrasound-guided femoral dialysis access placement: a single-center randomized trial. Clin J Am Soc Nephrol 2010; 5:235.
  56. Rabindranath KS, Kumar E, Shail R, Vaux EC. Ultrasound use for the placement of haemodialysis catheters. Cochrane Database Syst Rev 2011; :CD005279.
  57. Headley CM, Thompson CL, Carter M, et al. The role of real-time ultrasound and physical examination measurements in placement of cuffed-tunneled hemodialysis catheters. Nephrol Nurs J 2004; 31:407.
  58. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003; 14:527.
  59. Boyce JM. Prevention of central line-associated bloodstream infections in hemodialysis patients. Infect Control Hosp Epidemiol 2012; 33:936.
  60. Moran JE, Ash SR, ASDIN Clinical Practice Committee. Locking solutions for hemodialysis catheters; heparin and citrate--a position paper by ASDIN. Semin Dial 2008; 21:490.
  61. Chen FK, Li JJ, Song Y, et al. Concentrated sodium chloride catheter lock solution--a new effective alternative method for hemodialysis patients with high bleeding risk. Ren Fail 2014; 36:17.
  62. Smythe MA, Koerber JM, Mattson JC. The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest 2007; 131:1644.
  63. Yamamoto S, Koide M, Matsuo M, et al. Heparin-induced thrombocytopenia in hemodialysis patients. Am J Kidney Dis 1996; 28:82.
  64. Maki DG, Ash SR, Winger RK, et al. A novel antimicrobial and antithrombotic lock solution for hemodialysis catheters: a multi-center, controlled, randomized trial. Crit Care Med 2011; 39:613.
  65. Betjes MG, van Agteren M. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant 2004; 19:1546.
  66. Bleyer AJ, Mason L, Russell G, et al. A randomized, controlled trial of a new vascular catheter flush solution (minocycline-EDTA) in temporary hemodialysis access. Infect Control Hosp Epidemiol 2005; 26:520.
  67. Buturović J, Ponikvar R, Kandus A, et al. Filling hemodialysis catheters in the interdialytic period: heparin versus citrate versus polygeline: a prospective randomized study. Artif Organs 1998; 22:945.
  68. Campos RP, do Nascimento MM, Chula DC, Riella MC. Minocycline-EDTA lock solution prevents catheter-related bacteremia in hemodialysis. J Am Soc Nephrol 2011; 22:1939.
  69. Macrae JM, Dojcinovic I, Djurdjev O, et al. Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS). Clin J Am Soc Nephrol 2008; 3:369.
  70. Colì L, Donati G, Cianciolo G, et al. Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis. J Vasc Access 2006; 7:118.
  71. Dogra GK, Herson H, Hutchison B, et al. Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study. J Am Soc Nephrol 2002; 13:2133.
  72. Broom JK, Krishnasamy R, Hawley CM, et al. A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients--the HEALTHY-CATH trial. BMC Nephrol 2012; 13:146.
  73. Broom JK, O'Shea S, Govindarajulu S, et al. Rationale and design of the HEALTHY-CATH trial: a randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients. BMC Nephrol 2009; 10:23.
  74. Hendrickx L, Kuypers D, Evenepoel P, et al. A comparative prospective study on the use of low concentrate citrate lock versus heparin lock in permanent dialysis catheters. Int J Artif Organs 2001; 24:208.
  75. Hryszko T, Brzosko S, Mysliwiec M. Low concentration of heparin used for permanent catheters canal locking is effective and diminishes the risk of bleeding. Int Urol Nephrol 2013; 45:825.
  76. Kaneko Y, Iwano M, Yoshida H, et al. Natural saline-flush is sufficient to maintain patency of immobilized-urokinase double-lumen catheter used to provide temporary blood access for hemodialysis. Blood Purif 2004; 22:473.
  77. Mokrzycki MH, Jean-Jerome K, Rush H, et al. A randomized trial of minidose warfarin for the prevention of late malfunction in tunneled, cuffed hemodialysis catheters. Kidney Int 2001; 59:1935.
  78. Moran J, Sun S, Khababa I, et al. A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients. Am J Kidney Dis 2012; 59:102.
  79. Mozafar M, Samsami M, Sobhiyeh MR, et al. Effectiveness of aspirin on double lumen permanent catheter efficacy in ESRD. Nephrourol Mon 2013; 5:762.
  80. Nori US, Manoharan A, Yee J, Besarab A. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Am J Kidney Dis 2006; 48:596.
  81. Pervez A, Ahmed M, Ram S, et al. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia. J Vasc Access 2002; 3:108.
  82. Power A, Duncan N, Singh SK, et al. Sodium citrate versus heparin catheter locks for cuffed central venous catheters: a single-center randomized controlled trial. Am J Kidney Dis 2009; 53:1034.
  83. Hemmelgarn BR, Moist L, Pilkey RM, et al. Prevention of catheter lumen occlusion with rT-PA versus heparin (Pre-CLOT): study protocol of a randomized trial [ISRCTN35253449]. BMC Nephrol 2006; 7:8.
  84. Hemmelgarn BR, Moist LM, Lok CE, et al. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011; 364:303.
  85. de Oliveira Ramos Netto M, de Campos Nogueira MJ, Guedes EA. [Study of breast feeding]. Rev Esc Enferm USP 1978; 12:77.
  86. Filiopoulos V, Hadjiyannakos D, Koutis I, et al. Approaches to prolong the use of uncuffed hemodialysis catheters: results of a randomized trial. Am J Nephrol 2011; 33:260.
  87. Malo J, Jolicoeur C, Theriault F, et al. Comparison between standard heparin and tinzaparin for haemodialysis catheter lock. ASAIO J 2010; 56:42.
  88. Wang Y, Ivany JN, Perkovic V, et al. Anticoagulants and antiplatelet agents for preventing central venous haemodialysis catheter malfunction in patients with end-stage kidney disease. Cochrane Database Syst Rev 2016; 4:CD009631.
  89. Thomson PC, Morris ST, Mactier RA. The effect of heparinized catheter lock solutions on systemic anticoagulation in hemodialysis patients. Clin Nephrol 2011; 75:212.
  90. Holley JL, Bailey S. Catheter lock heparin concentration: effects on tissue plasminogen activator use in tunneled cuffed catheters. Hemodial Int 2007; 11:96.
  91. Ivan DM, Smith T, Allon M. Does the heparin lock concentration affect hemodialysis catheter patency? Clin J Am Soc Nephrol 2010; 5:1458.
  92. Ash SR, Mankus RA, Sutton JM, et al. Concentrated Sodium Citrate as Catheter Lock Solution. J Am Soc Nephrol 1999:A13750.
  93. Weijmer MC, van den Dorpel MA, Van de Ven PJ, et al. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol 2005; 16:2769.
  94. Ashman N. Efficacy of sodium citrate antimicrobial locks for reducing rates of catheter-related bacteremia. Am J Kidney Dis 2009; 54:1185; author reply 1185.
  95. Shanks RM, Sargent JL, Martinez RM, et al. Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces. Nephrol Dial Transplant 2006; 21:2247.
  96. Polaschegg HD, Sodemann K. Risks related to catheter locking solutions containing concentrated citrate. Nephrol Dial Transplant 2003; 18:2688.
  97. Grudzinski L, Quinan P, Kwok S, Pierratos A. Sodium citrate 4% locking solution for central venous dialysis catheters--an effective, more cost-efficient alternative to heparin. Nephrol Dial Transplant 2007; 22:471.
  98. Manns BJ, Scott-Douglas N, Tonelli M, et al. An economic evaluation of rt-PA locking solution in dialysis catheters. J Am Soc Nephrol 2014; 25:2887.
  99. Schenk P, Rosenkranz AR, Wölfl G, et al. Recombinant tissue plasminogen activator is a useful alternative to heparin in priming quinton permcath. Am J Kidney Dis 2000; 35:130.
  100. Gittins NS, Hunter-Blair YL, Matthews JN, Coulthard MG. Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomised controlled trial. Arch Dis Child 2007; 92:499.
  101. Allon M. Dialysis catheters and recombinant tissue plasminogen activator. N Engl J Med 2011; 364:1779; author reply 1779.
  102. Landry DL, Braden GL, Gobeille SL, et al. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol 2010; 5:1799.
  103. Zhang J, Wang B, Li R, et al. Does antimicrobial lock solution reduce catheter-related infections in hemodialysis patients with central venous catheters? A Bayesian network meta-analysis. Int Urol Nephrol 2017; 49:701.
  104. Kanaa M, Wright MJ, Akbani H, et al. Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial. Am J Kidney Dis 2015; 66:1015.
  105. Labriola L, Crott R, Jadoul M. Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant 2008; 23:1666.
  106. Yahav D, Rozen-Zvi B, Gafter-Gvili A, et al. Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis 2008; 47:83.
  107. Oguzhan N, Pala C, Sipahioglu MH, et al. Locking tunneled hemodialysis catheters with hypertonic saline (26% NaCl) and heparin to prevent catheter-related bloodstream infections and thrombosis: a randomized, prospective trial. Ren Fail 2012; 34:181.
  108. Moore CL, Besarab A, Ajluni M, et al. Comparative effectiveness of two catheter locking solutions to reduce catheter-related bloodstream infection in hemodialysis patients. Clin J Am Soc Nephrol 2014; 9:1232.
  109. Landry D, Braden G. Reducing catheter-related infections in hemodialysis patients. Clin J Am Soc Nephrol 2014; 9:1156.
  110. Agharazii M, Plamondon I, Lebel M, et al. Estimation of heparin leak into the systemic circulation after central venous catheter heparin lock. Nephrol Dial Transplant 2005; 20:1238.
  111. Markota I, Markota D, Tomic M. Measuring of the heparin leakage into the circulation from central venous catheters--an in vivo study. Nephrol Dial Transplant 2009; 24:1550.
  112. Pepper RJ, Gale DP, Wajed J, et al. Inadvertent postdialysis anticoagulation due to heparin line locks. Hemodial Int 2007; 11:430.
  113. Sombolos KI, Fragia TK, Bamichas GI, et al. Heparin solution locked in acute hemodialysis catheters: impact on activated partial thromboplastin time. ASAIO J 2003; 49:287.
  114. Schwab SJ, Buller GL, McCann RL, et al. Prospective evaluation of a Dacron cuffed hemodialysis catheter for prolonged use. Am J Kidney Dis 1988; 11:166.
  115. Lok CE, Appleton D, Bhola C, et al. Trisodium citrate 4%--an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant 2007; 22:477.
  116. Sungur M, Eryuksel E, Yavas S, et al. Exit of catheter lock solutions from double lumen acute haemodialysis catheters--an in vitro study. Nephrol Dial Transplant 2007; 22:3533.
  117. Polaschegg HD, Shah C. Overspill of catheter locking solution: safety and efficacy aspects. ASAIO J 2003; 49:713.
  118. Polaschegg HD. Loss of catheter locking solution caused by fluid density. ASAIO J 2005; 51:230.
  119. Polaschegg HD. Catheter locking-solution spillage: theory and experimental verification. Blood Purif 2008; 26:255.
  120. Moritz ML, Vats A, Ellis D. Systemic anticoagulation and bleeding in children with hemodialysis catheters. Pediatr Nephrol 2003; 18:68.
  121. Oran NT, Eser I. Impact of heparin locking frequency on preventing temporary dialysis catheter dysfunction in haemodialysis patients. J Ren Care 2008; 34:199.
  122. Niyyar VD. Catheter dysfunction: the role of lock solutions. Semin Dial 2012; 25:693.
  123. Zellweger M, Bouchard J, Raymond-Carrier S, et al. Systemic anticoagulation and prevention of hemodialysis catheter malfunction. ASAIO J 2005; 51:360.
  124. Gallieni M, Giordano A, Rossi U, Cariati M. Optimization of dialysis catheter function. J Vasc Access 2016; 17 Suppl 1:S42.
  125. Traynor JP, Walbaum D, Woo YM, et al. Low-dose warfarin fails to prolong survival of dual lumen venous dialysis catheters. Nephrol Dial Transplant 2001; 16:645.
  126. Wilkieson TJ, Ingram AJ, Crowther MA, et al. Low-intensity adjusted-dose warfarin for the prevention of hemodialysis catheter failure: a randomized, controlled trial. Clin J Am Soc Nephrol 2011; 6:1018.
  127. Abdul-Rahman I, Al-Howaish A. Warfarin versus aspirin in preventing tunneled hemodialysis catheter thrombosis: a prospective randomized study. HKJN 2007; 9:23.
  128. Twardowski ZJ. Stepwise Anticoagulation with Warfarin for Prevention of Intravenous Catheter Thrombosis. Hemodial Int 2000; 4:37.
  129. Liangos O, Gul A, Madias NE, Jaber BL. Long-term management of the tunneled venous catheter. Semin Dial 2006; 19:158.
  130. Raja RM, Fernandes M, Kramer MS, et al. Comparison of subclavian vein with femoral vein catheterization for hemodialysis. Am J Kidney Dis 1983; 2:474.
  131. Hansbrough JF, Narrod JA, Stiegman GV. Cardiac perforation and tamponade from a malpositioned subclavian dialysis catheter. Nephron 1982; 32:363.
  132. Barton BR, Hermann G, Weil R 3rd. Cardiothoracic emergencies associated with subclavian hemodialysis catheters. JAMA 1983; 250:2660.
  133. Brodersen HP, Korsten F, Modlich E, et al. Right atrial silicone catheters as angioaccess for hemodialysis with special emphasis to their complications. Geriatr Nephrol Urol 1997; 7:29.
  134. Kabutey NK, Rastogi N, Kim D. Conservative management of iatrogenic superior vena cava (SVC) perforation after attempted dialysis catheter placement: case report and literature review. Clin Imaging 2013; 37:1138.
  135. Wang CY, Liu K, Chia YY, Chen CH. Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion. Acta Anaesthesiol Taiwan 2009; 47:95.
  136. Kjellstrand CM, Merino GE, Mauer SM, et al. Complications of percutaneous femoral vein catheterizations for hemodialysis. Clin Nephrol 1975; 4:37.
  137. Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17:S1.
  138. Dunn J, Nylander W, Richie R. Central venous dialysis access: experience with a dual-lumen, silicone rubber catheter. Surgery 1987; 102:784.
  139. Atherikul K, Schwab SJ, Conlon PJ. Adequacy of haemodialysis with cuffed central-vein catheters. Nephrol Dial Transplant 1998; 13:745.
  140. Oliver MJ, Mendelssohn DC, Quinn RR, et al. Catheter patency and function after catheter sheath disruption: a pilot study. Clin J Am Soc Nephrol 2007; 2:1201.
  141. Daeihagh P, Jordan J, Chen J, Rocco M. Efficacy of tissue plasminogen activator administration on patency of hemodialysis access catheters. Am J Kidney Dis 2000; 36:75.
  142. Schwab SJ, Quarles LD, Middleton JP, et al. Hemodialysis-associated subclavian vein stenosis. Kidney Int 1988; 33:1156.
  143. Oguzkurt L, Tercan F, Torun D, et al. Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study. Eur J Radiol 2004; 52:293.
  144. Cimochowski GE, Worley E, Rutherford WE, et al. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron 1990; 54:154.
  145. Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6:722.
  146. NKF-DOQI Clinical Practice Guidelines for Vascular Access. VI. Acute hemodialysis vascular access — Noncuffed catheters. Am J Kidney Dis 2001; 37(Suppl 1):S146.
  147. NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997; 30:S150.
  148. Newman GE, Saeed M, Himmelstein S, et al. Total central vein obstruction: resolution with angioplasty and fibrinolysis. Kidney Int 1991; 39:761.
  149. Saad TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 1999; 34:1114.
  150. Marr KA, Sexton DJ, Conlon PJ, et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997; 127:275.
  151. Dahlberg PJ, Yutuc WR, Newcomer KL. Subclavian hemodialysis catheter infections. Am J Kidney Dis 1986; 7:421.
  152. Nielsen J, Ladefoged SD, Kolmos HJ. Dialysis catheter-related septicaemia--focus on Staphylococcus aureus septicaemia. Nephrol Dial Transplant 1998; 13:2847.
  153. Kairaitis LK, Gottlieb T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant 1999; 14:1710.
  154. Parienti JJ, Thirion M, Mégarbane B, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008; 299:2413.
  155. Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int 2005; 68:311.