Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Acute hemodialysis vascular access

INTRODUCTION

Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. Acute hemodialysis access should be easy to insert, available for immediate use, and trouble-free in the short-term.

Two currently available classes of device best meet these criteria:

  • Acute dialysis catheters
  • Cuffed, tunneled dialysis catheters

The basic aspects of these catheters and the potential complications that can occur will be reviewed here. The catheters used for chronic vascular access are discussed separately. (See "Chronic hemodialysis vascular access: Types and placement".)

ACUTE HEMODIALYSIS CATHETERS

Double-lumen, non-cuffed, non-tunneled hemodialysis catheters have become the preferred method for obtaining acute hemodialysis vascular access [1,2]. They are available from many manufacturers and are composed of many different plastics. The current polymers are rigid at room temperature to facilitate insertion but soften at body temperature to minimize vessel trauma and blood vessel laceration. The proximal and distal lumens should be separated by at least 2 cm to minimize recirculation. The continuous blood path made possible by the dual lumen design allows rapid blood flows and the use of a no heparin hemodialysis technique. (See "Hemodialysis anticoagulation".) These catheters come in a series of internal configurations including double D, Coaxial, and shotgun.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Fan, PY, Schwab, SJ. Vascular access: Concepts for the 1990s. J Am Soc Nephrol 1992; 3:1.
  2. Bander, SJ, Schwab, SJ. Central venous angioaccess for hemodialysis and its complications. Semin Dial 1992; 5:121.
  3. K/DOQI Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates Hemodialysis adequacy Peritoneal Dialysis Adequacy Vascular Access. Am J Kidney Dis 2006; 48(Suppl 1):S1.
  4. Oliver, MJ, Edwards, LJ, Treleaven, DJ, et al. Randomized study of temporary hemodialysis catheters. Int J Artif Organs 2002; 25:40.
  5. 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.
  6. Cheesbrough, JS, Finch, RJ, Burder, RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986; 154:579.
  7. 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.
  8. Schwab, SJ, Beathard, G. The hemodialysis catheter conundrum: Hate living with them, but can't live without them. Kidney Int 1999; 56:1.
  9. 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.
  10. Moss, AH, McLaughlin, MM, Lampert, KD, et al. Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access. Am J Kidney Dis 1988; 12:492.
  11. Klouche, K, Amigues, L, Deleuze, S, et al. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. Am J Kidney Dis 2007; 49:99.
  12. Swartz, R, Massana, J, Boyer, C, et al. Successful use of a cuffed central venous dialysis catheter inserted percutaneously. J Am Soc Nephrol 1994; 4:1719.
  13. Uldall, R, DeBruyne, M, Besley, M, et al. A new vascular access catheter for hemodialysis. Am J Kidney Dis 1993; 21:270.
  14. Silberzweig, JE, Sacks, D, Khorsandi, AS, Bakal, CW. Reporting standards for central venous access. J Vasc Interv Radiol 2003; 14:S443.
  15. Maya, ID, Allon, M. Outcomes of tunneled femoral hemodialysis catheters: Comparison with internal jugular vein catheters. Kidney Int 2005; 68:2886.
  16. 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.
  17. Gallieni, M, Conz, PA, Rizzioli, E, et al. Placement, performance and complications of the Ash Split Cath hemodialysis catheter. Int J Artif Organs 2002; 25:1137.
  18. Mosquera, DA, Gibson, SP, Goldman, MD. Vascular access surgery: A 2-year study and comparison with the Permcath. Nephrol Dial Transplant 1992; 7:1111.
  19. Duncan, ND, Singh, S, Cairns, TD, et al. Tesio-Caths provide effective and safe long-term vascular access. Nephrol Dial Transplant 2004; 19:2816.
  20. Suhocki, P, Conlon, P, Knelson, M, et al. Silastic cuffed catheters for hemodialysis vascular access: Thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996; 28:379.
  21. 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.
  22. Fan, PY. Acute vascular access: New advances. Adv Ren Replace Ther 1994; 1:90.
  23. Vanholder, R, Lameiere, N, Verbanck J, et al. Complications of subclavian catheters for hemodialysis: A 5 year prospective study in 257 consecutive patients. Int J Artif Organs 1982; 5:297.
  24. Edwards, H, King, TC. Cardiac tamponade from central venous catheters. Arch Surg 1982; 117:965.
  25. Bernard, RW, Stahl, WM. Subclavian vein catheterizations: a prospective study. I. Non-infectious complications. Ann Surg 1971; 173:184.
  26. Kwon, TH, Kim YL, Cho, DK. Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access. Nephrol Dial Transplant 1997; 12:1009.
  27. Kumwenda, MJ. Two different techniques and outcomes for insertion of long-term tunnelled haemodialysis catheters. Nephrol Dial Transplant 1997; 12:1013.
  28. 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.
  29. Geddes, CC, Walbaum, D, Fox, JG, Mactier, RA. Insertion of internal jugular temporary hemodialysis cannulae by direct ultrasound guidance - A propsective comparison of experienced and inexperienced operators. Clin Nephrol 1998; 50:320.
  30. Schenk, P, Rosenkranz, AR, Wolfl, G, et al. Recombinant tissue plasminogen activator is a useful alternative to heparin in priming quinton permcath. Am J Kidney Dis 2000; 35:130.
  31. 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.
  32. Schwab, SJ, Quarles, LD, Middleton, JP, et al. Hemodialysis associated subclavian vein stenosis. Kidney Int 1988; 33:1156.
  33. Schillinger, F, Schillinger, D, Montagnac, R, Milcent, T. Post catheterization vein stenosis in haemodialysis: Comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6:722.
  34. Cimochowski, GE, Worley, E, Rutherford, WE, et al. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron 1990; 54:154.
  35. Hernandez, D, Diaz, F, Rufino, M, et al. Subclavian vascular access stenosis in dialysis patients: Natural history and risk factors. J Am Soc Nephrol 1998; 9:1507.
  36. NKF-DOQI Clinical Practice Guidelines for Vascular Access. VI. Acute hemodialysis vascular access — Noncuffed catheters. Am J Kidney Dis 2001; 37(Suppl 1):S146.
  37. Efsing, HO, Lindblad, B, Mark, J, Wolff, T. Thromboembolic complications from central venous catheters: A comparison of three catheter materials. World J Surg 1983; 7:419.
  38. Stephens, WP, Lawler, W. Thrombus formation in central venous catheters. Lancet 1982; 2:664.
  39. Newman, GE, Saeed, M, Himmelstein, S, et al. Total central vein obstruction: Resolution with angioplasty and fibrinolysis. Kidney Int 1991; 39:761.
  40. 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.
  41. 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.
  42. Dahlberg, PJ, Yutuc, WR, Newcomer, KL. Subclavian hemodialysis catheter infections. Am J Kidney Dis 1986; 7:421.
  43. Nielsen, J, Ladefoged, SD, Kolmos, HJ. Dialysis catheter-related septicaemia - Focus on Staphylococcus aureus septicaemia. Nephrol Dial Transplant 1998; 13:2847.
  44. Parienti, JJ, Thirion, M, Megarbane, 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.
  45. Kairaitis, LK, Gottlieb, T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant 1999; 14:1710.
  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. Sesso, R, Barbosa, D, Leme, I, et al. Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: Effect of mupirocin ointment. J Am Soc Nephrol 1998; 9:1085.
  48. Chatzinikolaou, I, Finkel, K, Hanna, H, Boktour, M. Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections: A prospective, randomized study. Am J Med 2003; 115:352.
  49. 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.
  50. 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.
  51. 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.
  52. Marr, K, Sexton, D, Conlon, P, et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997; 127:275.
  53. Shaffer, D. Catheter related sepsis complicating long term tunneled central vein catheters: Management by guidewire exchange. Am J Kidney Dis 1995; 25:593.
white circle LOG IN
white circle DEMO