Hemodialysis Catheters

Abstract

As a busy dialysis and apheresis unit and a referral center for vascular access, we had 850 hemodialysis catheter insertions in 2004, and >16 000 since 1976. According to data from literature and our experience, insertion should be guided by real-time ultrasonography whenever possible. Trisodium citrate in various concentrations (4-30%) seems to be a preferable locking solution (local anticoagulant and antimicrobial activity, no systemic anticoagulation, low price). Mupirocin at the exit site decreases the incidence of local infection and sepsis. The possible additive beneficial effects of the locking solution (citrate) and exit-site care with antibiotic (mupirocin, gentamycin) should be explored. According to our experience, temporary non-tunneled single-lumen catheters (one or two), with citrate locking and mupirocin at exit site, can be successfully used as a long-term vascular access in selected patients. The complications rate (malfunction and infection) of these catheters is comparable to tunneled, permanent catheters, but with the important advantage of easier insertion, exchange and removal.

Hemodialysis Catheters With Citrate Locking in Critically Ill Patients With Acute Kidney Injury Treated With Intermittent Online Hemofiltration or Hemodialysis

“…Despite the favorable reports and recommendations regarding newly designed DL HD catheters with a gunshot‐tip design (17), the low blood flow problems have persisted. As shown by our previous experience (18) and the present study, SL catheters are still preferred over DL catheters in our clinical practice. Moreover, although we did not observe any significant acute insertion‐related complications, one should also be aware of more extensive mechanical trauma and the higher risk of bleeding at insertion, removal and replacement of DL compared to SL catheters.…”

Challenges of Caring for an Advanced Chronic Kidney Disease Patient with Severe Thrombocytopenia

“…The catheter choice, however, depends on the indication and treating physician, and reflects the findings of various reviews of the morbidity and longevity, the hospital or surgical availability, as well as personal experience 19. Cuffed and tunneled central venous dialysis catheters, which are specifically designed for HD treatment and are reserved for temporary use or as a last resort for patients with an exhausted peripheral vasculature, serious cardiac diseases, a reduced life expectancy, and perhaps for those who are particularly sensitive to recurrent venipuncture,20–22 might also be used as a common vascular access for treatment and blood sampling in some subsets of HD patients with diseases such as hematological disorders and malignancies 23. However, the only literature describing such a case was published by Wolfrum,24 in which the availability of a permanent dialysis catheter as not only dialysis access, but also as a parenteral route for various therapeutic agents, was described in a patient with hemorrhagic diathesis due to hemophilia 24.…”

Trisodium Citrate: An Alternative to Unfractionated Heparin for Hemodialysis Catheter Dwells

“…2,4 To maintain patency between dialysis procedures, hemodialysis catheters, both tunneled and untunneled, are routinely "locked" by injecting a volume of anticoagulant solution approximately equal to the actual lumen volume of the catheter. 2,5 This lumen volume can vary between types of catheters. 2,6 The locking solution remains in the catheter lumen between hemodialysis sessions (48-72 hrs) and is aspirated immediately before the next dialysis session.…”