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Review
. 2016 Mar;33(1):31-8.
doi: 10.1055/s-0036-1572547.

Update on Insertion and Complications of Central Venous Catheters for Hemodialysis

Peter R Bream Jr  1
Affiliations
Review

Update on Insertion and Complications of Central Venous Catheters for Hemodialysis

Peter R Bream Jr. Semin Intervent Radiol. 2016 Mar.

Abstract

Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed.

Keywords: central venous catheters; complications; hemodialysis; techniques.

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Figures

Fig. 1
Fig. 1
(a) Position of properly placed right internal jugular dialysis catheter. (b) Initial placement of left IJ catheter in obese patient. Note the placement of catheter tip deep in the right atrium (arrow). (c) Chest radiograph of same patient in b 24 hours after placement showing significant retraction of the catheter tip (arrow). This patient eventually presented with poor flows 2 weeks later, necessitating catheter exchange.
Fig. 2
Fig. 2
(a) Three image captures from out-of-plane ultrasound-guided needle placement into the right internal jugular vein. The IJ (white star) and carotid (white circle) are seen. The needle appears as a bright dot (yellow arrow) as it is advanced toward the vein. (b) Three-image captures from in-plane ultrasound-guided needle placement into the right internal jugular vein. The needle (yellow arrows) is clearly visible throughout its course from the skin to the IJ (white star). The carotid (white circle) is medial.
Fig. 3
Fig. 3
Cartoon by the author, showing measurement calculation for antegrade tunneling technique.
See this image and copyright information in PMC

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