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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 a 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].

Basic principles — Dialysis catheters usually have at least two lumens attached to two ports (blue and red colored). By convention, the red port identifies the “arterial” lumen that draws blood from the body (proximal/side opening[s]) and the blue port identifies the “venous” lumen for return of blood from the dialysis machine to the patient (the distal opening[s]). This direction of flow may occasionally be reversed by dialysis nurses if blood flow is limited in this conventional direction. The continuous blood path made possible by the dual lumen design allows rapid blood flows and a hemodialysis technique that does not require heparin. (See "Hemodialysis anticoagulation".)

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Literature review current through: Sep 2017. | This topic last updated: Aug 29, 2016.
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