Vascular Access for Renal Replacement Therapy

The incidence of acute kidney injury is high in critically ill patients admitted to the intensive care unit, leading to increased morbidity and mortality, particularly in those requiring renal replacement therapy (RRT). The placement of a dialysis catheter (DC) is essential to initiate RRT. DCs are categorized into uncuffed, non-tunneled dialysis catheters (NTDCs) for short-term use and easier bedside placement and cuffed, tunneled dialysis catheters (TDCs) for long-term RRT. The choice of the DC placement site is crucial to enhance patient outcomes and reduce mechanical, thrombotic, and infectious complications. Current evidence recommends prioritizing the right internal jugular vein as the first choice, the femoral vein as the second choice, the left internal jugular vein as the third choice, and the subclavian vein as the last choice. Guidelines advocate for real-time ultrasound guidance during DC insertion to minimize procedural complications. Additionally, meticulous aseptic procedures are essential during insertion and manipulation, along with the implementation of infection control measures for optimal care of DCs.