Traditional and non-traditional strategies to optimize catheter function: go with more flow

Kidney Int. 2010 Dec;78(12):1218-31. doi: 10.1038/ki.2010.332. Epub 2010 Sep 29.


In the United States, over 340,000 patients have end-stage renal disease treated by hemodialysis (HD) and are dependent on a reliable vascular access. In over 80% of patients initiating HD, this access is the central venous catheter (CVC). Although the CVC has many advantages that make it desirable for dialysis initiation-ease of insertion, unnecessary maturation time, and availability for immediate use-it is not without significant disadvantages. The substantial morbidity and mortality associated with CVC use has been well documented in the literature. Initiating and maintaining HD patients using a CVC is suboptimal from the perspective of both patient care and associated long-term costs. Yet, in the United States, the most common HD access-related event is replacement of any vascular access type with a CVC. Although in recent years greater effort has be made to reduce CVC use, some patients are unable to have a functioning arteriovenous fistula or graft created due to exhaustion of vessels from previous permanent accesses or limiting comorbidities. In patients dependent on long-term CVC use, the primary problems are due to malfunction ('poor flows') or infection. Catheter malfunction leads to inadequate dialysis, the need for costly and inconvenient intervention, and reduced quality of life. This review will focus on the etiology, prevention, and management of CVC-related malfunction.

Publication types

  • Review

MeSH terms

  • Arteriovenous Shunt, Surgical
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation*
  • Catheters / adverse effects
  • Equipment Failure
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Renal Dialysis / adverse effects
  • Renal Dialysis / instrumentation*
  • Upper Extremity Deep Vein Thrombosis / etiology
  • Upper Extremity Deep Vein Thrombosis / prevention & control