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. 2016 Sep 27:3:2054358116669128.
doi: 10.1177/2054358116669128. eCollection 2016.

Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters

Edward Clark  1 , Joanne Kappel  2 , Jennifer MacRae  3 , Christine Dipchand  4 , Swapnil Hiremath  1 , Mercedeh Kiaii  5 , Charmaine Lok  6 , Louise Moist  7 , Matthew Oliver  8 , Lisa M Miller  9 ; Canadian Society of Nephrology Vascular Access Work Group
Affiliations

Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters

Edward Clark et al. Can J Kidney Health Dis. .

Abstract
in English, French

Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.

En situation d’insuffisance rénale aigüe, les cathéters de dialyse non tunnelisés sont utilisés lorsqu’un accès vasculaire est requis de façon urgente pour entreprendre un traitement de suppléance de la fonction rénale. L’implantation de ce type de cathéter se fera préférablement dans la veine jugulaire interne droite sinon dans la veine fémorale. Il est possible de réduire de façon significative les complications mécaniques liées à son insertion en suivant la procédure par échographie. La veine jugulaire interne droite constitue également le site privilégié pour l’insertion d’un cathéter de dialyse tunnelisé. Toutefois, dans ce cas, le deuxième choix se portera sur la veine jugulaire interne gauche plutôt que sur la veine fémorale. Dans tous les cas, l’insertion du cathéter devra se faire du côté opposé à une fistule en cours de maturation, ou d’une fistule ou d’une greffe anticipée. De nombreux modèles de cathéters de grand diamètre, à double lumière et à pointes variées sont disponibles, mais aucun d’eux n’a démontré de performance supérieure à l’usage.

Keywords: catheter insertion; catheter removal; exit-site care; nontunneled hemodialysis catheters; site selection; tunneled hemodialysis catheter.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prevalence of central venous catheters among incident hemodialysis patients in Canada.
Figure 2.
Figure 2.
Radiograph of a right internal jugular tunneled central venous catheter with catheter tip placed in right atrium. Source. Atlas of Dialysis Vascular Access. esrdncc.org/wp-content/uploads/2015/12/Access-Atlas.pdf.
See this image and copyright information in PMC

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