Interventional Nephrology and Dialysis: Managing the Complications of Long‐Term Tunneled Dialysis Catheters

Abstract

The Kidney Disease Outcomes and Quality Initiative (K/DOQI) guidelines call for a significant increase in the use of natural vein fistulas. Long-term tunneled dialysis catheters (LTTDCs) will have an important role in facilitating the maturation of natural vein fistulas. LTTDCs also functions as the access of last resort in patients who refuse or have exhausted other forms of permanent vascular access. This article, which is based on the authors' experience as interventional nephrologists, discusses factors influencing catheter function. In addition, the article reviews common complications associated with dialysis catheter insertion, including immediate, short-term, and long-term complications. The topics reviewed include stenoses, thrombus formation, fibrin sheath formation, infections, and vascular ingrowth. Suggestions for management are also discussed.

Success rate of first haemodialysis post tunnelled dialysis catheter insertion

“…Placement in the right atrium enables high blood flow rates to be achieved and the right internal jugular offers the most direct access to the atrium. It has to be noted however that in obese individuals and large breasted females that the tip of the catheter moves up when they change from a supine to an upright position and thus the operator has to take cognisance of this at the time of insertion [7]. Catheter tip migration also occurs more commonly with catheters that are placed within the subclavian vessels.…”

Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners

“…This order is based on complication rates from lowest to highest. For example, Schon and Whittman found that the incidence of stenosis was 27% for CVCs placed in the right internal jugular vein in comparison with 40% for those placed in the left internal jugular vein [27]. As such, there must be discussion between the professional placing the CVC and the nephrologist as to the optimal desired location.…”

“…Kinking can potentially be prevented by bending the catheter in the shape of a C or U prior to tunneling the line. This creates a contiguous arc in the catheter to avoid constriction of the lumen [27]. …”

“…Tissue ingrowth into the CVC itself has been reported and has entrapped the CVC onto the endothelial surface of the vessel. This, potentially, would require either leaving the CVC in the vessel permanently or thoracotomy for removal [27, 35]. …”

Six years of experience with nightly home hemodialysis access

“…2 All patients not allergic to cefazolin were given 1 g intravenously (IV) prophylactically before procedure. If allergic to cefazolin, the patient was given 20 mg/kg vancomycin IV.…”