title: Haemodialysis catheters in the intensive care unit.
abstract: Ten to 15% of critically ill patients need renal replacement therapy (RRT) for severe acute kidney injury. The dialysis catheter is critical for RRT quality and efficiency. Catheters have several properties that must be optimized to promote RRT success. The distal tip has to be located in a high blood flow location, which means central venous territory. Therefore, catheters are mostly inserted into the right internal jugular vein or in femoral veins. External diameter should vary from 12 to 16 Fr in order to ensure adequate blood flow inside the catheter. Lumen shapes are theoretically designed to limit thrombotic risk with low turbulences and frictional forces against the internal wall. With low aspiration pressure, distal tip shape has to deliver sufficient blood flow, while limiting recirculation rate. Catheter material should be biocompatible. Despite in vitro data, no strong evidence supports the use of coated catheters in the ICU in order to reduce infectious risk. Antibiotic "lock" solutions are not routinely recommended. Ultrasound guidance for catheterization significantly decreases mechanical complications. Clinicians should select the optimal catheter according to patient body habitus, catheter intrinsic properties and RRT modality to be used.
authors.affiliation: Anaesthesiology and critical care medicine department, Edouard-Herriot hospital, 5, place d'Arsonval, 69437 Lyon cedex 03, France. Electronic address: huriaux.laetitia@gmail.com.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Huriaux
authors.affiliation: Anaesthesiology and critical care medicine department, Edouard-Herriot hospital, 5, place d'Arsonval, 69437 Lyon cedex 03, France. Electronic address: p.costille@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Costille
authors.affiliation: Anaesthesiology and critical care medicine department, Pasteur 2 hospital, CHU de Nice, 30, avenue de la voie romaine, 06001 Nice cedex 1, France. Electronic address: quintard.h@chu-nice.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Quintard
authors.affiliation: Anaesthesiology and critical care medicine department, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: d.journois@invivo.edu.
authors.forename: Didier
authors.initials: D
authors.lastname: Journois
authors.affiliation: Department of critical care medicine, centre for critical care nephrology, the CRISMA (clinical research, investigation, and systems modeling of acute illness) center, university of Pittsburgh, Pittsburgh, PA, USA. Electronic address: kellumja@ccm.upmc.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Anaesthesiology and critical care medicine department, Edouard-Herriot hospital, 5, place d'Arsonval, 69437 Lyon cedex 03, France. Electronic address: thomas.rimmele@chu-lyon.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
mesh_terms: D057785:Catheters; D003422:Critical Care / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D007362:Intensive Care Units; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods
keywords: Acute kidney injury; CRRT; Dialysis catheters; Intensive care; Renal replacement therapy