Central venous catheters as access for chronic hemodialysis

Résumé

Although discouraged in previous Kidney Disease Outcomes Quality Initiative (K-DOQI) and European best practice guidelines (EPBG), central venous catheters as access for chronic hemodialysis are being increasingly used in hemodialysis units. Tunnelled, cuffed, double-lumen catheters are currently preferred for dialysis patients. The advantage of central venous catheters is that these devices can be quickly and easily inserted and provide immediate access for hemodialysis The most common complications are delayed complications, consisting of catheter dysfunction secondary to thrombotic events and catheter migration, catheter-related bacteraemia (CRB) and central venous stenosis. Intrinsic catheter-related thrombosis is the principal complication associated with hemodialysis catheters and is the main cause of catheter loss. Intraluminal lytic enzyme therapy must be tried. If this therapy is unsuccessful in restoring blood flow, the catheter must be changed after previously obliterating the fibrin sheath. Central venous stenosis is usually asymptomatic. In symptomatic lesions, the treatment of choice is percutaneous angioplasty. There are few data on the benefits of stents in hemodialysis. CRB is a complication that carries high morbidity and mortality. Various preventive measures have been advocated to diminish the infection rate. The adoption of a strict aseptic protocol alone significantly reduces the incidence of CRB. Early treatment is the most effective measure to prevent the fatal outcome that sometimes occurs.