Do catheters harm the patient?

There is an increasing use of central venous catheters (CVCs) as a first-line vascular access in incident hemodialysis (HD) patients. CVCs are associated with short-term complications related to the catheter insertion procedure and with long-term complications as a consequence of the intravascular interaction of catheter material with the venous endothelium. Removal of CVCs is also associated with specific risks, such as pulmonary or air embolism. Bacteremia and sepsis, however, are the most important risks associated with CVCs. In incident HD patients, the mortality risk from infection is highest during the first 6 months after dialysis initiation, and has steadily increased over the last decade. The relative risk for infection from CVCs in HD patients now clearly exceeds the risk for catheter-related infections in peritoneal dialysis (PD) patients. CVCs should therefore always be the last preference for vascular access in HD. The option for PD should always be evaluated before using CVCs as a permanent vascular access in end-stage renal disease patients.