Nephrol Dial Transplant (2002) 17: 1368-1373
© 2002 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Central venous catheters: many questions, few answers
Department for Vascular Surgery, Stadtklinik Baden-Baden, Baden-Baden, Germany
Keywords: catheter-associated bacteraemia; central venous catheters; complications; haemodialysis; haemofiltration; review
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Introduction
Large-bore central venous catheters (CVC) play an important role in the treatment of acute renal insufficiency [1]. They represent the only means for immediate vascular access in cases of urgently needed renal replacement therapy (RRT). Bedside implantation is possible even in the emergency room and during cardiopulmonary resuscitation.
Cuffed tunnelled catheters are used for RRT of intermediate duration and even for chronic haemodialysis in patients where peripheral arteriovenous access is felt to be problematic or impossible. Recently, subcutaneous port devices have been developed, suggesting that in the near future central venous access might become an acceptable and reliable alternative to a functioning arteriovenous fistula.
Thus, it seems worthwhile to update the literature with respect to what we know and do not know about acute and chronic central venous access for haemodialysis.
Which catheter material and design?
A variety of plastic materials including polyvinyl chloride, polyethylene, polyurethane, and silicone is used in the production
Tunnelled or non-tunnelled catheter?
Single- or double-lumen catheters, or ‘twin’ catheters?
Which central vein?
Subclavian vein
Internal jugular vein
External jugular vein
Common femoral vein
Percutaneous or surgical implantation?
Complications
Catheter dysfunction and occlusion
Catheter-associated bacteraemia
Central-venous obstructions
Long-term renal-replacement therapy
Arteriovenous or central-venous access?
Port device for long-term RRT?
Conclusion
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