Complications of Hemodialysis Catheters

Hemodialysis catheters are a commonly used vascular access type in hemodialysis patients. Efforts to reduce the use of catheters have been unsuccessful over two decades. According to the latest USRDS data for 2023 more than 80% of ESRD patients in the United States start hemodialysis with a catheter. Moreover, about 3–10% of the patients who begin hemodialysis treatment with a mature AV fistula will require a vascular catheter within their first year. Studies have confirmed that hemodialysis catheters are associated with more complications as compared to AV fistulas and grafts. These complications are classified into two types: acute, occurring during insertion and within the first week, and chronic, occurring (or manifest) after that period. Incidence, cause, and management for each of these complications are discussed thoroughly within this chapter. Specific emphasis on preventive methods to reduce the catheter related complications are discussed. Hemodialysis catheter associated blood stream infection is discussed in detail due to its importance as the second leading cause of mortality among ESRD patients. Many of these problems can be reduced by following proper policies including better catheter handling.