Managing the complications of long-term tunneled dialysis catheters

The Kidney Disease Outcomes and Quality Initiative (K/DOQI) guidelines call for a significant increase in the use of natural vein fistulas. Long-term tunneled dialysis catheters (LTTDCs) will have an important role in facilitating the maturation of natural vein fistulas. LTTDCs also functions as the access of last resort in patients who refuse or have exhausted other forms of permanent vascular access. This article, which is based on the authors' experience as interventional nephrologists, discusses factors influencing catheter function. In addition, the article reviews common complications associated with dialysis catheter insertion, including immediate, short-term, and long-term complications. The topics reviewed include stenoses, thrombus formation, fibrin sheath formation, infections, and vascular ingrowth. Suggestions for management are also discussed.