Complex central venous catheter insertion for hemodialysis

Area of Science:

• Nephrology
• Vascular Access
• Interventional Radiology

Background:

• Central venous catheter (CVC) use has not decreased in the UK despite payment reforms.
• Increased patient survival in hemodialysis leads to prolonged CVC exposure.
• CVC use poses risks of infection, occlusion, and central venous stenosis, complicating future access.

Purpose of the Study:

• To discuss the challenges of CVC insertion in hemodialysis patients with exhausted traditional access sites.
• To present advanced CVC techniques for challenging venous access scenarios.
• To detail techniques, complications, and functional longevity of alternative CVC placements.

Main Methods:

• Review of advanced CVC insertion techniques for hemodialysis patients.
• Discussion of specific methods including translumbar, transocclusion, transcollateral, transjugular IVC, and transhepatic catheterization.
• Analysis of associated complications and expected device function.

Main Results:

• No decrease in CVC use observed despite policy changes.
• Growing prevalence of central venous occlusion as a sequela of long-term CVC use.
• Demonstration of feasibility for complex CVC placements in patients with limited options.

Conclusions:

• Central venous occlusion is an increasing challenge in hemodialysis vascular access.
• Advanced CVC techniques offer solutions for patients with exhausted traditional sites.
• Careful technique selection and management are crucial for optimizing outcomes in complex CVC cases.