Should Nephrology Training Programs Continue to Train Fellows in the Placement of Temporary Hemodialysis Catheters?

Dialysis access procedure training for the nephrologist

“…Currently, there is no standardized approach for nephrology fellows to be trained in NTHDC insertions and procedural competence is not routinely assessed . In addition, the practicality and utility of training all nephrology fellows in NTHDC insertion has also come under fire …”

“…The debate over whether fellowship programs should continue to train fellows to place NTHDC is largely opinion based in the absence of robust data. The most compelling reason for retaining this requirement is to reduce the reliance of nephrologists on other specialties to deliver urgent dialysis‐a lifesaving therapy . Second, it can be argued that if the nephrologists themselves are placing NTHDC then they are in a better position to discuss the risks and benefits of performing this procedure.…”

“…On the other hand, the need to prioritize educational goals can be a deterrent for all programs to train fellows in NTHDC placement as the time required to successfully place a NTHDC might encroach on more educational undertakings . Moreover, since majority of practices do not require nephrologists to place NTHDC, the likelihood of losing proficiency over time in NTHDC insertion is high .…”

“…6 In addition, the practicality and utility of training all nephrology fellows in NTHDC insertion has also come under fire. 7 The debate over whether fellowship programs should continue to train fellows to place NTHDC is largely opinion based in the absence of robust data. The most compelling reason for retaining this requirement is to reduce the reliance of nephrologists on other specialties to deliver urgent dialysis-a lifesaving therapy.…”

“…The most compelling reason for retaining this requirement is to reduce the reliance of nephrologists on other specialties to deliver urgent dialysis-a lifesaving therapy. 7,8 Second, it can be argued that if the nephrologists themselves are placing NTHDC then they are in a better position to discuss the risks and benefits of performing this procedure. Moreover, given that the interest of internal medicine residents in procedural fields like cardiology and gastroenterology has increased over time, 9 giving up ownership of our procedures might hurt our efforts to attract procedurally minded residents to nephrology.…”