Dialysis Access Catheters

A vascular access catheter is indicated when a patient requires renal replacement therapy. Common indications for renal replacement therapy in the ICU include refractory acidosis, hyperkalemia, volume overload, symptomatic uremia, or overdose with a dialyzable toxin. Risks include arterial puncture, pneumothorax, infection, venous obstruction or thrombosis, or air embolus. The right internal jugular (IJ) is the preferred site for placement of a temporary dialysis catheter, followed by the femoral vessels. Catheters in the left IJ will require two angulations on course to the superior vena cava, which can lead to difficulty achieving adequate flow for dialysis. The subclavian vessels are the least preferred site due to the potential for subclavian vein stenosis.