Table 1 Prevention and management of catheter dysfunction

Materials

Silicone or polyurethane catheter

Heparin coated catheters are not recommended

Diameters

12- to 16-French (4–5 mm)

Length

For the upper sites: at least 15 cm to obtain right atrium placement for soft DC, superior vena cava for rigid DC

For the lower sites: probably at least 24 cm

Lumens

Dual lumen catheter

Two single-lumen catheters less easy to place but at least as accurate as dual lumen catheters

Tunnelization

Lower rate of DC dysfunctions but placement more difficult

Choice of the insertion site

Femoral and right jugular sites better than left jugular site

Right internal jugular site should be preferred in intermittent hemodialysis if Q _B has to be higher than 200 ml/min

Subclavian sites to be avoided

Ultrasound guidance especially for jugular sites

Preserve vascular network

Positioning of the catheter

Upper sites

Tips of the catheter placed next to the right atrium in the superior vena cava

Check chest radiography

Lower sites

Tips of the catheter placed in the inferior vena cava

During renal replacement therapy (RRT)

Flush

Use saline solution flushes before and after every RRT session

Pressure

Check pressure greater than −250 mmHg on the inflow site

Check pressure <250 mmHg on the outflow site

Lock

Anticoagulant lock, i.e., heparin after every RRT

Clamp

Careful clamp closing after every RRT

In case of dysfunction

Patient

Try to change patient position

Flush

Try to flush catheter lumens with saline solutions

Catheter

Try to rotate the catheter

Lumens

Try to reverse catheter lumens. Prolonged port reversal not recommended due to recirculation which compromises efficacy

Locks

Fibrinolytic locks are not evaluated and are not yet recommended

Dose of RRT

Check previous KT/V in case of intermittent hemodialysis session and consider catheter replacement

Education of the team