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Decision making in vascular access: International perspectives on dialysis catheter choice
Nicholas Inston1, Brian Rifkin2, Joris Rotmans3
1Department of Vascular Surgery and Renal Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Insights
Clinician choice of tunneled central venous catheters (TCVCs) for hemodialysis is based on practical factors, not evidence. More comparative studies are needed to guide selection and improve patient outcomes.
Area of Science:
- Nephrology
- Vascular Access
- Medical Device Technology
Background:
- Tunneled central venous catheters (TCVCs) are crucial for hemodialysis but have known complications like infection and thrombosis.
- Limited comparative data exists for different TCVC designs, leading current guidelines to recommend clinician judgment for selection.
Purpose of the Study:
- To investigate how clinicians select dialysis catheters in practice.
- To identify the factors influencing the decision-making process for TCVC selection.
Main Methods:
- An international online survey was distributed to clinicians using SurveyMonkey.
- The survey collected data on clinician characteristics, practice setting, and factors influencing catheter choice, perceived complications, and confidence in existing technologies.
Main Results:
- 111 clinicians from 37 countries participated, including nephrologists, vascular surgeons, and interventional radiologists.
- Catheter performance, availability, and ease of insertion were primary selection factors.
- Thrombosis/fibrin sheath and infection were the most common complications limiting catheter lifespan; confidence in current technologies was moderate to low.
Conclusions:
- Dialysis catheter selection is driven by practical considerations rather than robust comparative evidence.
- A significant evidence gap exists, underscoring the need for comparative clinical studies to optimize TCVC selection and patient outcomes.
Background:
Tunneled central venous catheters (TCVCs) remain an important component of hemodialysis vascular access despite recognized complications including infection, thrombosis, and catheter dysfunction. Although multiple catheter designs and technologies are available, there is limited comparative evidence supporting the use of one catheter type over another. Current KDOQI vascular access guidelines acknowledge this lack of evidence and recommend that catheter selection should rely on clinician judgment. This study aimed to explore how clinicians select dialysis catheters in routine practice and identify factors influencing decision-making.
Methods:
A standardized questionnaire was developed to capture clinician perspectives regarding dialysis catheter use. The survey was distributed internationally using SurveyMonkey via QR codes and web links through professional networks including the Vascular Access Society and the Dialysis Catheter Collaborative. Participation was voluntary and anonymous. The survey was open between January and March 2026. Questions addressed respondent characteristics, practice setting, catheter insertion volume, factors influencing catheter selection, perceived complications limiting catheter lifespan, confidence in current catheter technologies, and priorities for future research. Responses were analyzed descriptively.
Results:
A total of 111 clinicians from 37 countries responded. Participants included nephrologists/interventional nephrologist (n = 47; 42.3%), vascular surgeons (n = 44; 39.6%), interventional radiologists (n = 15; 13.5%). Catheter performance (63%), availability (42.3%), and ease of insertion (39.6%) were the most frequently cited factors influencing catheter choice. Thrombosis or fibrin sheath formation was considered the complication most often limiting catheter lifespan (52.3%), followed by infection (29.7%). Confidence in current catheter technologies to prevent complications was generally moderate to low.
Conclusions:
Dialysis catheter selection is primarily influenced by practical considerations rather than strong comparative evidence. These findings highlight a substantial evidence gap and support the need for robust comparative clinical studies to guide catheter choice and improve outcomes for patients requiring TCVC.
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