Sohail Mohammad Ahsan, Vachharajani Tushar J, Anvari Evamaria
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
Kidney Int Rep. 2021 Oct 11;6(12):2958-2968. doi: 10.1016/j.ekir.2021.09.009. eCollection 2021 Dec.
Hemodialysis-central venous catheter (HD-CVC) insertion is a most often performed procedure, with approximately 80% of patients with end-stage kidney disease in the United States initiating kidney replacement therapy through a HD-CVC. Certain adverse events arising from HD-CVC placement, including catheter-related bloodstream infections (CR-BSIs), thrombosis, and central vein stenosis, can complicate the clinical course of patients and lead to considerable financial impact on the health care system. Medical professionals with different training backgrounds are responsible for performing this procedure, and therefore, comprehensive operator guidelines are crucial to improve the success rate of HD-CVC insertion and prevent complications. In this review article, we not only discuss the basic principles behind the use of HD-CVCs but also address frequently asked questions and myths regarding catheter asepsis, length selection, tip positioning, and flow rate assessment.
血液透析中心静脉导管（HD-CVC）置入是一种最常进行的操作，在美国约80%的终末期肾病患者通过HD-CVC开始肾脏替代治疗。HD-CVC置入引发的某些不良事件，包括导管相关血流感染（CR-BSIs）、血栓形成和中心静脉狭窄，可使患者的临床病程复杂化，并给医疗保健系统带来相当大的经济影响。具有不同培训背景的医学专业人员负责执行此操作，因此，全面的操作指南对于提高HD-CVC置入成功率和预防并发症至关重要。在这篇综述文章中，我们不仅讨论了使用HD-CVC的基本原则，还解答了有关导管无菌、长度选择、尖端定位和流速评估的常见问题及误解。
