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Placement of tunnelled haemodialysis catheters-interventional standard
Bernd Schröppel1, Lucas Bettac1, Lena Schulte-Kemna1
1Section of Nephrology, University Hospital, Ulm, Germany.
Insights
Tunnelled haemodialysis catheters (tHDCs) are an option for select patients when native arteriovenous fistulas are not feasible. Nephrologists play a key role in tHDC planning, creation, and monitoring to improve patient care and access.
Area of Science:
- Nephrology
- Vascular Access Surgery
Background:
- Native arteriovenous fistulas are preferred for haemodialysis but not always feasible.
- Tunnelled haemodialysis catheters (tHDCs) serve as an alternative for specific patient groups.
- Limited access to vascular surgery necessitates increased nephrologist involvement in vascular access management.
Purpose of the Study:
- To review current standards for tHDC creation and patient selection.
- To discuss strategies for minimizing infectious complications and catheter thrombosis.
- To highlight advancements in catheter placement techniques and their implications.
Main Methods:
- Review of current literature on tHDC creation and management.
- Analysis of patient selection criteria for tHDC use.
- Evaluation of novel catheter placement techniques, including ultrasound- and electrocardiogram-guidance.
- Discussion of interventional nephrology training requirements.
Main Results:
- tHDCs are a viable option for selected haemodialysis patients.
- Nephrologist involvement in vascular access planning and creation is crucial.
- Ultrasound- and electrocardiogram-guided techniques offer potential benefits but add complexity.
- Effective strategies exist to mitigate risks of infection and thrombosis.
Conclusions:
- Nephrologists require enhanced skills in vascular access management, including tHDC placement.
- Interventional nephrology training programs are essential for equipping nephrologists with these skills.
- A structured approach to choosing insertion methods based on patient factors and resources is necessary.
Abstract:
While the native arteriovenous fistula remains the first choice in vascular access for most haemodialysis patients, tunnelled haemodialysis catheters (tHDCs) continue to be an option in selected patients. Since timely access to vascular surgery-due to delayed referral or resource limitations-is not always possible, nephrologists have to become more actively involved in planning, creation and monitoring of vascular access. Moreover, this approach could also strengthen patient-centred care in nephrology. This article reviews the current standard in tHDC creation, patient selection and strategies to mitigate the risk of infectious complications and catheter thrombosis. Presentation of novel developments in catheter placement with ultrasound-guided or electrocardiogram-guided positioning, their benefits and possible disadvantages emphasizes the complexity of vascular access planning. We offer an approach for the choice of insertion method, depending on selected side and existing resources and focus on the necessity and required resources of 'interventional nephrology' training programs.
