THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Vascular Access for Continuous Renal Replacement Therapy

Abstract

A working vascular access is essential for performing continuous renal replacement therapy (CRRT) efficiently and without interruption. Dual-lumen temporary hemodialysis catheters are the catheters of choice, although tunneled catheters can also be utilized if therapy is expected to be prolonged. Hemodialysis catheters have to be inserted under ultrasound guidance by trained personnel, using aseptic conditions. The right internal jugular vein is the preferred site. Catheter malfunction and catheter-related infections can be reduced by adhering to preventive guidelines such as ultrasound guidance for placement, strict hand hygiene, gauze dressings, and sterile techniques during catheter handling. Antibiotic or antiseptic-coated catheters and lock solutions may be beneficial in certain patients, but these are not widely used due to the concern for resistant organisms and allergic reactions.

Sudden hypotension occurring after 4 days of left-sided central catheter placement

“…Among the delayed complications, delayed vascular perforation by CVC is a rare but life-threatening complication (2,(8)(9)(10). Leftsided approach, large diameter catheters and old age were known as the risk factors for delayed vascular perforation (4,8).…”

“…The common immediate complications include failure to place the catheter, arterial puncture, hematoma, air embolism, pneumothorax and hemothorax (2,7). Chest X-ray should be checked to ensure appropriate placement of catheter tip and no immediate complication (2,4,6). The delayed complications include infection, venous thrombosis, catheter migration and embolization (2,7).…”

“…A well-functioning hemodialysis catheter is essential for successful CRRT (2,4). Hemodialysis catheters can be inserted at three different access sites such as the internal jugular vein, the subclavian vein and the femoral vein.…”

“…Hemodialysis catheters can be inserted at three different access sites such as the internal jugular vein, the subclavian vein and the femoral vein. While right internal jugular vein was the first choice for catheter placement, subclavian veins are used as a last resort due to the risk of central venous stenosis (4,5). For all hemodialysis catheter insertions, the use of bedside ultrasound guidance is recommended for increased success rate and decreased complication rates (2,4,6).…”

“…Immediate chest computed tomography should be performed to assess the precise location and extent of vascular injury and the management varies from conservative care to emergent operation, which depends on the severity of vascular injury as well as patient's general status (2)(3)(4)8).…”