Table 6.

Characteristics, monitoring and complications of dialysis catheters for continuous RRT (7,52,53)

CharacteristicRecommendationAdditional Considerations
TypeNontunneled temporary catheter (level of evidence 2D)Avoid subclavian catheters, use ultrasound guidance for insertion; obtain chest x-rays before use (IJ or subclavian); no need for topical antibiotics or antibiotic locks for nontunneled dialysis catheters
Catheter lengthRIJ 12–15 cm, LIJ 15–20 cm, Fem 19–24 cm
Catheter diameter12–13 Fr
PositionCatheter tip in the SVC (caval-atrial junction, <4 cm from RA) with arterial lumen facing the mediastinum
MonitoringTrigger for alarmAction
Access pressure>50–70 mm Hg pressure ∆ from operating pointEvaluate for catheter malfunction (clots, kinks, malposition)
Return pressure>50–70 mm Hg pressure ∆ from operating pointEvaluate for catheter malfunction (clots, kinks, malposition)
Complications
 Acute complications (<1% to 2%)Hemorrhage/hematoma, venous perforation, arterial puncture, pneumothorax, air embolism
 Subacute complicationsInfectiona: CR-BSI 1.6–5.5 episodes/1000 catheter d or exit site infection
Catheter malfunction: fibrin sheath formation, thrombus within catheter, catheter kinks, catheter fracture or disconnection, catheter malposition or migration, catheter tip adherent to vessel wall
  • RIJ, right internal jugular; LIJ, left internal jugular; Fem, femoral; Fr, French; SVC, superior vena cava; RA, right atrium; ∆, change; CR-BSI, catheter related-blood stream infection.

  • a Extrapolated from data of tunneled hemodialysis catheters (54,55).