ABSTRACT

The choice of hemodialysis vascular access for renal replacement therapy in the intensive care unit (ICU) setting is determined by a number of factors, including patient acuity, which determines the need for immediate vascular access, dialysis modality, and anticipated duration of hemodialysis support. For the patient requiring immediate dialysis, a temporary noncuffed catheter may be placed at the bedside; on the other hand, if it were anticipated that the patient requires long-term dialysis support, placement of a cuffed tunneled catheter would be more appropriate. The hemodialysis catheter is a unique venous access device. Unlike other central venous catheters, the hemodialysis catheter supports both blood infusion and withdrawal at relatively high flow rates. Continuous renal replacement therapies require blood flow rates on the order of 50-150 ml/min, whereas intermittent hemodialysis therapies generally necessitate blood flow rates in the 300-500 ml/min ranges.