Implantation of a hemodialysis catheter directly in the right atrium due to exhaustion of vascular access

Introduction: Patients on permanent hemodialysis need constant and secure vascular access with optimal flow to perform the procedure. Failure to provide such access can lead to life-threatening deterioration of the patient's condition. Case Presentation: We report a case of implantation of a hemodialysis catheter directly in the right atrium (RA) in an emergency in a 46 year-old woman, placed on permanent hemodialysis (HD) for nine years due to end-stage renal disease with exhausted opportunities for vascular access over the years and unsuitable for peritoneal dialysis. After a consultation between a cardiac surgeon, a vascular surgeon and an interventional radiologist, a decision was made to directly implant a permanent catheter for HD in the superior vena cava (SVC). The operation was performed as a matter of urgency, operative access was through ministerotomy and the catheter was implanted directly in the right atrium (RA) due to thrombosis and fibrosis of the SVC. No cardiac complications associated with the procedure were observed in the postoperative period. On the first postoperative day, HD was performed, followed by others according to the therapeutic plan. The patient was discharged from the Cardiac Surgery Department on the 7th postoperative day. Conclusion: The use of open surgical access and the implantation of a permanent HD catheter directly into the RA can be considered a life-saving procedure in HD patients with acute uremic syndrome and exhausted vascular access.