Hemodialysis catheters.

As a busy dialysis and apheresis unit and a referral center for vascular access, we had 850 hemodialysis catheter insertions in 2004, and >16 000 since 1976. According to data from literature and our experience, insertion should be guided by real-time ultrasonography whenever possible. Trisodium citrate in various concentrations (4-30%) seems to be a preferable locking solution (local anticoagulant and antimicrobial activity, no systemic anticoagulation, low price). Mupirocin at the exit site decreases the incidence of local infection and sepsis. The possible additive beneficial effects of the locking solution (citrate) and exit-site care with antibiotic (mupirocin, gentamycin) should be explored. According to our experience, temporary non-tunneled single-lumen catheters (one or two), with citrate locking and mupirocin at exit site, can be successfully used as a long-term vascular access in selected patients. The complications rate (malfunction and infection) of these catheters is comparable to tunneled, permanent catheters, but with the important advantage of easier insertion, exchange and removal.