Tunneled femoral dialysis catheter: Practical pointers

Abstract

One of the most challenging aspects of providing end-stage kidney disease care is to achieve adequate long-term access to the bloodstream to support hemodialysis (HD) therapy. Although upper extremity arteriovenous fistula remains the vascular access of choice for patients on HD, complications such as central venous stenosis, access thrombosis, or exhaustion of suitable access sites in the upper extremity, ultimately result in pursuing vascular access creation in the lower extremity. The current review focuses on the indications, contraindications, and clinically relevant practical procedural tips to successfully place a tunneled femoral dialysis catheter. The review highlights some of the prevailing misconceptions regarding femoral catheter placement practices.

Malposition of a Femoral Tunneled Dialysis Catheter through a Patent Foramen Ovale

“…It has been suggested that TDC with a femoral approach and tip placement in the right atrium may potentially inhibit the success of achieving adequate blood flow and potentially promote the development of long fibrin sheaths leading to shorter patency of the access. 18 In a prospective observational study, TDC tips with a femoral approach placed at the upper third of the IVC or the junction of the IVC and right atrium resulted in 6-and 12-month primary patency rates of 66.6% AE 12.6% and 54.2% AE 16.6%, respectively. 19 While other studies have shown lower primary patency rates at 6 months ranging from 55 to less than 20% when placed in the lower IVC, though a direct comparison between these studies is not easily made.…”