Vascular access for kidney replacement therapies: few evidences, lots of good sense

Abstract

The recommendations for the management of catheters in chronic hemodialysis patients cannot be transposed to intensive care patients. As the renal replacement therapy sessions carried out in intensive care must be at low clearance and prolonged, an adequate dialysis dose can be delivered with a maximum blood flow rate of 200 ml/min. However, the value of the blood flow rate achieved is not the only criterion guaranteeing good functioning of the catheter. Flow rate must be continuous and laminar, which imposes an adequate inlet pressure in the circuit. The right internal jugular site with the tip of the catheter positioned at the pericavoatrial junction and the femoral site with the tip positioned in the inferior vena cava are recommended as first choice. An average duration of kidney replacement therapy in intensive care of less than one week simplifies the maintenance of catheter patency and the prevention of infections. The specific measures used in chronic haemodialysis for long-term catheters (tunnelling, impregnated devices, locks) have not demonstrated their benefit and their relevance is debated.