Central dialysis catheters

Ideal permanent hemodialysis access consists of a permanent upper extremity arteriovenous fistula or a graft. Newly placed arteriovenous fistulas should be allowed to mature for at least 1 month, and a graft should be placed at least 3 weeks before use. However, intravenous catheters, both temporary nontunneled and long-term tunneled, provide immediate access for patients requiring hemodialysis. These catheters are indicated when patients require hemodialysis before maturation of the fistula or while awaiting renal transplantation or the institution of ambulatory peritoneal dialysis. For some patients, in whom no other access is possible, a tunneled dialysis catheter must function as permanent access. Dialysis catheters represent a special breed of externally tunneled central catheters and therefore require special attention. Proper maintenance of long-term dialysis catheters is critical for the longevity of satisfactory dialysis.