Central Venous Access for Hemodialysis

In the United States, more than 5 million central venous catheters (CVCs) are placed every year, translating to more than 15 million days of treatment with CVCs for different purposes. CVCs are useful tools to administer medications, fluids, to collect blood samples, and exert a pivotal role in the setting of hemodialysis (HD) treatments in patients affected by either acute kidney injury or end-stage renal disease. The principal types of CVCs are tunneled (or cuffed) and nontunneled catheters. The use of tunneled CVCs is preferred due to the lower risk of infections and their better performance for delivery of dialytic dose compared to nontunneled CVCs. The right internal jugular vein is a large superficial vein, which has easy ultrasound visualization, with a straight course into the superior vena cava and right atrium, representing the first choice for CVC insertion. This peculiarity reduces the risk of CVC malposition and allows high blood flow for HD. An inadequate placement of CVC for HD can result in acute complications in 5% to 19% of cases, while late complications can be represented by atrial perforation, cardiac tamponade, and hemothorax, frequently linked to prolonged use of nontunneled CVC. The most common and potentially life-threatening catheter complication is represented by CVC-related infection, occurring in 1.1–5.5 cases per 1000 CVC days. Catheter dysfunction, with reduced patency of the device, can be attributed to CVC-related thrombosis and central venous stenosis, which are the most common causes of vascular access withdrawal.