Dialysis Catheter Placement

The Kidney Disease Outcomes Quality Initiative (K/DOQI) outlines vascular access management for hemodialysis patients. Of these guidelines, the following should be taken into consideration by interventional radiologists involved in the placing catheters for access in hemodialysis patients

1. patient evaluation including history of prior central venous catheters, pacemakers, prior vascular access failure, coagulation disorders, valvular heart disease
2. tunneled catheters should be placed when dialysis access is needed for greater than 3 weeks
3. right internal jugular vein access is preferred with the tip of the catheter in the right atrium
4. catheter related infections should be managed as follows:
• catheter site infection with negative blood cultures - treat with topical antibiotics; do not remove catheter unless there is no response to topical treatment in which case catheter should be exchanged over a wire to preserve venous access
• bacteremia - treat with systemic antibiotics appropriate for cultured organism; if patient is clinically unstable remove the catheter; if the patient is clinically stable the catheter should only be removed if the patient is symptomatic (fever, elevated WBC) after 36 hours of treatment with antibiotics

REFERENCES

Patel AA, Tuite CM, Trerotola SA. K/DOQI Guidelines: what should an interventionalist know? Semin Intervent Radiol 2004;21(2):119-24.