Practice survey on tunneled dialysis catheter placement by nephrologists in France

Renal replacement therapy (RRT) ensures the survival of patients with end-stage renal disease. It requires vascular access, such as an arteriovenous fistula or a tunneled central venous catheter. Catheters are inserted by different specialists using different techniques.

We conducted a practice survey on tunneled catheter placement in France developed by the French Intensive Renal Network (FIRN) commission. A comprehensive questionnaire was distributed via social networks to all dialysis centers in France.

Given the low response rate from other facilities, only responses from university hospitals were analyzed. Tunneled catheters are inserted by nephrologists in 68% of French university hospitals, of which only 20% use fluoroscopy for right jugular and femoral placement, and 40% for left jugular placement. The procedure is most often performed outside the operating room, in a dedicated room. Of the centers studied, 19% use antibiotic prophylaxis. The average time to insertion is around 48 hours for nephrologists, compared to 1 to 2 weeks for other specialists. Serious complications are rare but do occur and can be life-threatening. Anticoagulation and dual antiplatelet therapy are discontinued for this procedure. A few centers use tunneled catheters in acute renal failure and for plasma exchange.

Our survey shows that nephrologists place tunneled dialysis catheters in the majority of French university hospitals, enabling rapid access to the procedure. This procedure is often performed without fluoroscopy but under ultrasound guidance. Fluoroscopy remains the gold standard. Echocardiography, being less invasive than fluoroscopy, could improve guidance and enable early diagnosis of serious complications. The rest of the survey presents the various types of practices observed and could serve as a basis for developing best practice recommendations.