Vascular: Central Venous Dialysis Catheterization

General

• Can Use Immediately
• Generally a Temporary Measure Until Acute Renal Failure Resolves or More Definitive Access is Available
  • Prolonged Use Can Induce Central Stenosis
• Best Site: Right Internal Jugular Vein
  • Left Side Jeopardizes Venous Patency for Future Grafts (Most Patients are Right Hand Dominant)
  • Higher Risk of Stenosis in Subclavian
  • Higher Risk of Infection in Femoral

Non-Tunneled Catheter (Vascath)

• Only Used as a Temporary Measure (< 2-3 Weeks) – High Risk of Infection with Prolonged Use
• Size: 12-14 Fr (Larger Than Typical Triple Lumen CVC Line)
  • Smaller Size Struggles with Adequate Blood Flow
  • Larger Size Has Higher Risk of DVT
• Most Often Double-Lumen but Triple-Lumen Catheters are Available
• Placed Similar to Routine Central Venous Catheter (CVC)
  • *See Surgical Critical Care: Central Venous Catheter

Tunneled Catheter (Permacath/Hickman)

• Allows Long-Term Use if Other Options Unavailable
• Tunneled Under the Skin