Thread by @edgarvlermamd

Hemodialysis 101: Venous Catheter Access #Nephpearls #DialysisDirector

HD Catheters: Nominal flow > 400 mL/min (actual flow 350 mL/min) can rarely be obtained and usually flow is limited to a range closer to 300 mL/min
#Nephpearls #DialysisDirector

HD Catheters: Order of preference for various sites of insertion
📌 Optimal site is R IJ since venous pathway to the RA is relatively short and straight
📌 Avoid SC Vein due to ⬆️ rate of insertion related complications
📌 L IJ is not optimal
#Nephpearls #DialysisDirector

Femoral vein approach
📌 “Previously” thought to be high risk for infections
📌 CATHEDIA Study Group: Comparable rates of infection and time to catheter tip colonization (14 days) with Femoral vs IJ Catheters
👉🏼 cjasn.asnjournals.org/content/clinja…
#Nephpearls #DialysisDirector

Femoral Catheters
📌 Need to be at least 20 cm length so that tip is in IVC to allow better flow and minimize recirculation
📌 CATHEDIA Study Group: Delivered URR and Kt/V were similar with Femoral and IJ Catheters
👉🏼 cjasn.asnjournals.org/content/clinja…
#Nephpearls #DialysisDirector

Femoral Catheters
📌 ⬆️ risk of infection in obese patients (BMI > 28) 👉🏼 extent of this risk “probably” depends on distribution of body fat
#Nephpearls #DialysisDirector

European 🇪🇺 Best Practices Group order of preference for location of insertion
📌 R IJ is preferred, followed by L IJ
📌 Use of Femoral vein is discouraged
📌 Use of SC vein is discouraged (due to frequent stenosis)
#Nephpearls #DialysisDirector
👉🏼 academic.oup.com/ckj/article/3/…

Anatomic variability of internal jugular vein on ultrasound
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Complications of CVC insertion
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Mupirocin ointment treatment of
catheter exit site to decrease Staphylococcus colonization

⬇️ Catheter infection rate

⬆️ Catheter survival rate

⚠️ There is however, concern about the risk of long-term emergence of Mupirocin resistant organisms
#Nephpearls #DialysisDirector

In patients with nasal 👃 carriage of Staphylococcus, nasal decolonization has been shown to reduce the rate of CLABSI
👉🏼 ncbi.nlm.nih.gov/m/pubmed/24150…
#Nephpearls #DialysisDirector

Treatment of cuffed hemodialysis catheter infections
#Nephpearls #DialysisDirector