The durability of temporary hemodialysis catheter by insertion sites

INTRODUCTION: Hemodialysis is a lifesaving procedure to replace the functions of the kidney, either temporarily or permanent (continuous hemodialysis). Temporary dialysis is indicated among patients with sudden renal dysfunction, particularly who develop life threatening conditions such as electrolyte imbalance, drug/substance intoxication, fluid overload, uremia, and patients with chronic kidney disease who are waiting for the available renal transplant, AV fistula maturation, or injury/malfunction at their regular vascular access. Hemodialysis is done with the use of a tube-like tool called catheter. There are several points in our body that can be used as the site for catheter insertion, including internal jugular, femoral, external jugular, and subclavian veins. The difference of the vascular characteristics and anatomy require clinicians to consider and choose the right catheter and site for its insertion. These variations then suggest that the durability or patency of a catheter could be influenced by the site of insertion, and it can be assessed according to the duration of catheter placement until it is required to be removed. Removal of catheter can be physiological in origin (elective removal because it is no longer needed) or pathological (infection, tissue injury, mechanical complication/malfunctions, and other catheter-related comorbidities). In this study, we assess the durability or patency of a catheter from the time of its insertion until it is removed due to the pathological reasons through the literatures. EVIDENCE ACQUISITION: Literatures were gathered from PubMed and Google Scholar database. Advanced Google Scholar and Pubmed search (using PubMed Search Builder) was conducted with the keywords used were ((“durability of temporary hemodialysis catheter”) OR (“durability of dialysis catheter”) OR (“temporary dialysis catheter insertion site”)) AND (“infection” OR “complication”). We also reviewed the articles cited in the literatures to broaden the search results. EVIDENCE SYNTHESIS: Most of the articles reviewed in this study were observational studies, followed by RCTs. Internal jugular vein was the most common chosen site for catheterization; with longer catheter patency and less complications reported if compared with the other sites. Femoral vein was also an effective choice besides IJV with shorter catheter durability and more frequent infectious complications reported, chiefly if its usage was prolonged. CONCLUSIONS: Internal jugular vein has the longest durability compared by the other site, which corresponds with the results of previous studies and consensus. Frequent reports of infections associated with femoral vein catheterization must be taken into account before doing such invasive procedure.