Hemodialysis catheters and ports

Area of Science:

• Nephrology
• Vascular Surgery
• Medical Imaging

Background:

• Cuffed tunneled catheters are a standard for hemodialysis vascular access in end-stage renal disease.
• The right internal jugular vein is the preferred insertion site.
• Complications historically posed challenges for catheter placement.

Purpose of the Study:

• To detail the percutaneous placement of cuffed tunneled catheters for hemodialysis.
• To highlight the role of ultrasound and fluoroscopy in safe and effective catheter insertion.
• To introduce subcutaneous ports as a potential alternative vascular access.

Main Methods:

• Percutaneous insertion of cuffed tunneled catheters using real-time ultrasound and fluoroscopy.
• Description of placement techniques and variations for different catheter types.
• Evaluation of preliminary data for subcutaneous ports compared to tunneled catheters.

Main Results:

• Real-time imaging significantly reduces the incidence and severity of complications.
• The right internal jugular vein approach is well-supported by evidence.
• Subcutaneous ports show promise for higher flow rates and lower infection rates.

Conclusions:

• Ultrasound and fluoroscopy-guided placement ensures safe and effective hemodialysis catheter insertion.
• Cuffed tunneled catheters remain a vital vascular access option.
• Subcutaneous ports represent a promising alternative for hemodialysis vascular access.