Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

Central venous catheters (CVC) continue to remain a common modality of vascular access in end stage kidney disease patients maintained on hemodialysis. The increased morbidity and mortality associated with CVC, when compared to arteriovenous fistulas and grafts, is a serious health problem and a big challenge to the nephrology community. An article “Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly” written by Nabil J. Haddad, Sheri Van Cleef , Anil K. Agarwal and published in the Volume 10, 2017 issue of The Open Urology & Nephrology Journal, presents the pros and cons of CVC, in addition to the different complications and excessive economical costs related to their use.

According to the authors, a CVC is placed in the acute setting when immediate treatment can be lifesaving.   For long term therapy though, the complications can be life threatening secondary to a poorly functioning catheter, central venous stenosis or blood stream infection (BSI).

The dysfunctional catheter leads to suboptimal dialysis clearance and impacts on the patients general wellness and quality of life.  If bacteremia is noted by positive blood cultures the course of treatment requires long-term antibiotic therapy with the possibility of sepsis and extended hospitalization.  Lastly the central venous stenosis (CVS) may require the patient to undergo both endovascular procedures and surgical intervention to correct the stenosis.

The authors conclude the best plan of care for the patient who requires renal replacement therapy is early referral to a nephrologist and vascular surgeon for placement of an arteriovenous fistula or a graft.  Early intervention decreases the incidence of morbidity and mortality with the goal of improving patient outcomes, quality of life and financial stewardship of healthcare resources.

The full article can be found in The Open Urology & Nephrology Journal, 2012, 5, (Suppl 1: M3) 12-18, at  https://benthamopen.com/FULLTEXT/TOUNJ-5-12