Severe access recirculation secondary to free flow between the lumens of a dual-lumen dialysis catheter

Over the last decade, it has been increasingly recognized that recirculation is present to some extent in all dual-lumen dialysis catheters. In addition, despite the recognition that dual-lumen dialysis catheters are not ideal as long-term hemodialysis access, their use for this purpose has increased secondary to both poor vascular access in an older and sicker dialysis population as well as their convenience. Although infection and thrombosis remain the most common complications of dialysis catheters, we report a case of severe access recirculation secondary to free flow between the two lumens of a tunneled, cuffed silicone dual-lumen dialysis catheter. We take this opportunity to discuss recirculation in dialysis catheters and to review potential causes of catheter breakdown.