Sharma Mukesh, Tong Wei Lue, Thompson Dustin, Vachharajani Tushar J
Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, Nevada, USA.
Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Cardiovasc Diagn Ther. 2023 Feb 28;13(1):281-290. doi: 10.21037/cdt-22-426. Epub 2023 Jan 15.
Hemodialysis remains the most frequently chosen kidney replacement modality across the world. A well-functioning dialysis vascular access is critical to providing successful dialysis therapy. Despite its drawbacks, central venous catheter is commonly used as a vascular access to initiate hemodialysis therapy in acute and chronic settings. The growing recognition of providing patient centric care and per recommendations from the recently published Kidney Disease Outcome Quality Initiative (KDOQI) Vascular Access Guidelines, selecting the appropriate patient population for a central venous catheter placement involves implementing the End Stage Kidney Disease (ESKD) Life-Plan strategy. The current review examines the circumstances and challenges that increasingly lead to the hemodialysis catheter being the default and the only available choice for patients. The current review outlines the clinical scenarios for selecting an appropriate patient for hemodialysis catheter use for short-term or long-term needs. The review further discusses clinical pointers to assist with the decision-making process on estimation on prospective catheter length selection, particularly in the intensive care unit setting without the aid of conventional fluoroscopic guidance. A hierarchy of conventional and non-conventional access sites is proposed based on KDOQI guidance and multi-disciplinary author experience. Non-conventional sites are reviewed, including complications and technical guidance, for trans-lumbar IVC, trans-hepatic, trans-renal, and other exotic sites.
血液透析仍然是全球最常选用的肾脏替代方式。功能良好的透析血管通路对于提供成功的透析治疗至关重要。尽管存在缺点，但中心静脉导管在急性和慢性情况下通常被用作启动血液透析治疗的血管通路。随着对以患者为中心的护理的日益重视以及最近发布的《肾脏病预后质量倡议》（KDOQI）血管通路指南的建议，为中心静脉导管置入选择合适的患者群体涉及实施终末期肾病（ESKD）生命计划策略。本综述探讨了越来越多地导致血液透析导管成为患者默认且唯一可用选择的情况和挑战。本综述概述了为满足短期或长期需求而选择合适患者使用血液透析导管的临床场景。该综述进一步讨论了临床要点，以协助在没有传统荧光透视引导的情况下，特别是在重症监护病房环境中，进行前瞻性导管长度选择估计的决策过程。根据KDOQI指南和多学科作者经验，提出了传统和非常规通路部位的分级。对非常规部位进行了综述，包括经腰静脉下腔静脉、经肝、经肾和其他特殊部位的并发症及技术指导。
