Temporary hemodialysis catheters: recent advances

Abstract

The insertion of non-tunneled temporary hemodialysis catheters (NTHCs) is a core procedure of nephrology practice. While urgent dialysis may be life-saving, mechanical and infectious complications related to the insertion of NTHCs can be fatal. In recent years, various techniques that reduce mechanical and infectious complications related to NTHCs have been described. Evidence now suggests that ultrasound guidance should be used for internal jugular and femoral vein NTHC insertions. The implementation of evidence-based infection-control 'bundles' for central venous catheter insertions has significantly reduced the incidence of bloodstream infections in the intensive care unit setting with important implications for how nephrologists should insert NTHCs. In addition, the Cathedia Study has provided the first high-level evidence about the optimal site of NTHC insertion, as it relates to the risk of infection and catheter dysfunction. Incorporating these evidence-based techniques into a simulation-based program for training nephrologists in NTHC insertion has been shown to be an effective way to improve the procedural skills of nephrology trainees. Nonetheless, there are some data suggesting nephrologists have been slow to adopt evidence-based practices surrounding NTHC insertion. This mini review focuses on techniques that reduce the complications of NTHCs and are relevant to the practice and training of nephrologists.

Figure 1

Frequent and serious complications of temporary (non-tunneled) hemodialysis catheter insertion.

Figure 2

Anatomic variation of the internal jugular vein relative to the common carotid artery. Right-sided, axial section (viewed from above). *54% of those with internal jugular veins anterolateral to the common carotid artery overlap the artery by ⩾75% of its diameter. Variations not shown: lateral (0–84%) and far lateral (0–4%), both with no overlap; up to 18% of internal jugular veins are not visible or are thrombosed. Adapted from: Maecken T et al. Crit Care Med 2007; 35(S5):S178.

Figure 3

Anatomic variation of the common femoral vein relative to the common femoral artery. Right-sided, axial section (viewed from above). *Over 25% overlap between the common femoral vein and common femoral artery occurs in 8% of patients. 65% of patients have some degree of overlap. Adapted from: Baum PA et al. Radiology 1989; 173:775-777.