Hemodialysis Access Catheters

  • Christopher R. IngrahamEmail author
  • Karim Valji


Greater than 60 % of patients with end-stage renal disease initiate dialysis by a central venous catheter, and approximately 20 % of all dialysis patients are undergoing dialysis via a central venous catheter at any point in time. Given the widespread use of central venous catheters for dialysis access, this chapter will serve as a comprehensive overview of the topic, including a review of both tunneled and non-tunneled catheters, site selection, techniques for placement, and management of device-related complications.


Central venous catheter Central venous access techniques Temporary hemodialysis catheter Tunneled hemodialysis catheter 


  1. 1.
    Chapter 3: Clinical Indicators and Preventive Care. 2014. Accessed June 19 2015 at http://www.usrds.or/2014/view/v2_03.aspx.
  2. 2.
    Vats HS. Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis. 2012;19:188–94.CrossRefPubMedGoogle Scholar
  3. 3.
    III. NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37:S137–81.Google Scholar
  4. 4.
    Asif A. Interventional nephrology. 1st ed. New York: McGraw Hill; 2012.Google Scholar
  5. 5.
    Vascular Access Work G. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.Google Scholar
  6. 6.
    Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant. 2004;19:670–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosius WT, Kneebone PH. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology. 2000;217:89–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Beenen L, van Leusen R, Deenik B, Bosch FH. The incidence of subclavian vein stenosis using silicone catheters for hemodialysis. Artif Organs. 1994;18:289–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Cimochowski GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron. 1990;54:154–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant. 1991;6:722–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates. J Vasc Interv Radiol. 2013;24:1295–302.CrossRefPubMedGoogle Scholar
  12. 12.
    Oliver MJ, Edwards LJ, Treleaven DJ, Lambert K, Margetts PJ. Randomized study of temporary hemodialysis catheters. Int J Artif Organs. 2002;25:40–4.PubMedGoogle Scholar
  13. 13.
    Deshpande KS, Hatem C, Ulrich HL, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med. 2005;33:13–20; discussion 234–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 2000;58:2543–5.CrossRefPubMedGoogle Scholar
  15. 15.
    van de Wetering MD, van Woensel JB. Prophylactic antibiotics for preventing early central venous catheter Gram positive infections in oncology patients. Cochrane Database Syst Rev. 2007;24(1):CD003295.Google Scholar
  16. 16.
    Guttmann DM, Trerotola SO, Clark TW, et al. Malfunctioning and infected tunneled infusion catheters: over-the-wire catheter exchange versus catheter removal and replacement. J Vasc Interv Radiol. 2011;22:642–6; quiz 6.CrossRefPubMedGoogle Scholar
  17. 17.
    Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention (CDC) Dialysis Bloodstream Infection (BSI) prevention collaborative protocol. 2015. At:
  19. 19.
    Hoggard J, Saad T, Schon D, et al. Guidelines for venous access in patients with chronic kidney disease. A Position Statement from the American Society of Diagnostic and Interventional Nephrology, Clinical Practice Committee and the Association for Vascular Access. Semin Dial. 2008;21:186–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10:R162.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Herscu G, Woo K, Weaver FA, Rowe VL. Use of unconventional dialysis access in patients with no viable alternative. Ann Vasc Surg. 2013;27:332–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Gupta A, Karak PK, Saddekni S. Translumbar inferior vena cava catheter for long-term hemodialysis. J Am Soc Nephrol. 1995;5:2094–7.PubMedGoogle Scholar
  23. 23.
    Ross J. An alternative approach to the central circulation from above the diaphragm. Semin Dial. 2004;17:307–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Younes HK, Pettigrew CD, Anaya-Ayala JE, et al. Transhepatic hemodialysis catheters: functional outcome and comparison between early and late failure. J Vasc Interv Radiol. 2011;22:183–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Smith TP, Ryan JM, Reddan DN. Transhepatic catheter access for hemodialysis. Radiology. 2004;232:246–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Wong JK, Sadler DJ, McCarthy M, Saliken JC, So CB, Gray RR. Analysis of early failure of tunneled hemodialysis catheters. AJR Am J Roentgenol. 2002;179:357–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Miller DL, O’Grady NP, Society of Interventional R. Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology for venous catheter placement and maintenance. J Vasc Interv Radiol. 2012;23:997–1007.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol. 2007;3:138–53.CrossRefPubMedGoogle Scholar
  29. 29.
    Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000;342:476–82.CrossRefPubMedGoogle Scholar
  30. 30.
    Kashuk JL, Penn I. Air embolism after central venous catheterization. Surg Gynecol Obstet. 1984;159:249–52.PubMedGoogle Scholar
  31. 31.
    Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106:164–77.CrossRefPubMedGoogle Scholar
  32. 32.
    Garg N, Moorthy N, Goel PK. Intracardiac aspiration for life-threatening air embolism during cardiac catheterization in tetralogy of Fallot: an aborted sudden death. J Invasive Cardiol. 2012;24:E294–6.PubMedGoogle Scholar
  33. 33.
    Beathard GA, Urbanes A. Infection associated with tunneled hemodialysis catheters. Semin Dial. 2008;21:528–38.CrossRefPubMedGoogle Scholar
  34. 34.
    Hoen B. Infective endocarditis: a frequent disease in dialysis patients. Nephrol Dial Transplant. 2004;19:1360–2.CrossRefPubMedGoogle Scholar
  35. 35.
    Mokrzycki MH, Jean-Jerome K, Rush H, Zdunek MP, Rosenberg SO. A randomized trial of minidose warfarin for the prevention of late malfunction in tunneled, cuffed hemodialysis catheters. Kidney Int. 2001;59:1935–42.CrossRefPubMedGoogle Scholar
  36. 36.
    Coli L, Donati G, Cianciolo G, et al. Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis. J Vasc Access. 2006;7:118–22.PubMedGoogle Scholar
  37. 37.
    O’Mara NB, Ali S, Bivens K, Sherman RA, Kapoian T. Efficacy of tissue plasminogen activator for thrombolysis in central venous dialysis catheters. Hemodial Int. 2003;7:130–4.CrossRefPubMedGoogle Scholar
  38. 38.
    Janne d’Othee B, Tham JC, Sheiman RG. Restoration of patency in failing tunneled hemodialysis catheters: a comparison of catheter exchange, exchange and balloon disruption of the fibrin sheath, and femoral stripping. J Vasc Interv Radiol. 2006;17:1011–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Oliver MJ, Mendelssohn DC, Quinn RR, et al. Catheter patency and function after catheter sheath disruption: a pilot study. Clin J Am Soc Nephrol. 2007;2:1201–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Durbec O, Viviand X, Potie F, Vialet R, Albanese J, Martin C. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med. 1997;25:1986–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e419S–94.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Asmarats L, Fernandez-Palomeque C, Martinez-Riutort JM, Bethencourt A. Right atrial thrombosis associated with hemodialysis catheter: first description of recurrence in a poorly understood problem. J Thromb Thrombolysis. 2015;39:254–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Yevzlin AS. Hemodialysis catheter-associated central venous stenosis. Semin Dial. 2008;21:522–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Levit RD, Cohen RM, Kwak A, et al. Asymptomatic central venous stenosis in hemodialysis patients. Radiology. 2006;238:1051–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Maya ID, Saddekni S, Allon M. Treatment of refractory central vein stenosis in hemodialysis patients with stents. Semin Dial. 2007;20:78–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.University of WashingtonSeattleUSA
  2. 2.University of WashingtonSeattleUSA

Personalised recommendations