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Table 1 Prevention and management of catheter dysfunction

From: How to deal with dialysis catheters in the ICU setting

Choice of the dialysis catheters
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