The hemodialysis catheter conundrum: hate living with them, but can't live without them.
BACKGROUND
Hemodialysis requires reliable recurrent access to the circulation. On a chronic basis, this has been best provided by the use of arteriovenous fistulae and arteriovenous grafts. In recent years, hemodialysis catheters have come to play an increasingly important role in the delivery of hemodialysis. The use of both temporary as well as cuffed hemodialysis catheters has emerged as a significant boon for both patients and practicing nephrologists. The complications, however, associated with each of these hemodialysis catheters, both in terms of anatomic, thrombotic, and infectious issues, have emerged as a major problem with their continued use. This significant morbidity and complication rate has forced many nephrologists to face a basic conundrum: they have come to hate having to deal with the problems inherent in catheter usage, but the enormous utility of these devices have forced physicians to accept the fact they cannot live without them in their current practice.


METHODS
We used a comprehensive literature review to describe the types, use and dilemmas of hemodialysis catheters.


RESULTS
This article provides a comprehensive review of both the benefits inherent with the use of these hemodialysis catheters while cataloging their complications and offering some possible solutions.


CONCLUSIONS
Hemodialysis vascular access catheters are essential in the maintenance of hemodialysis vascular access. However, they have a significant infectious, thrombotic, anatomic complication rate that are detailed with proposed problem-solving guidelines.
Duke University Medical Center, Durham, North Carolina, USA.
S J
SJ
Schwab
G
G
Beathard
D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D007239:Infections / Q000209:etiology; D006435:Renal Dialysis / Q000295:instrumentation*