The KDOQI 2019 guidelines suggest that placement of a tunneled (cuffed) dialysis catheter is a valid option, supported by the goal of hemodialysis access use for limited duration (eg, <3 months) [5]. In such cases, when AV access is expected to be ready for use in the short term, it is preferred to place tunneled dialysis catheters in the extremity opposite to the extremity that is anticipated for AV access creation or revision. The KDOQI experts tout that in urgent dialysis initiation (eg, <1 month), a tunneled cuffed femoral CVC may be acceptable until the AV access is created and usable. The option to use the femoral vein allows for preservation of upper extremity vasculature for the pending AV access creation. The KDOQI 2019 guidelines regards it as reasonable to place a tunneled dialysis catheter for a long term or indefinite duration in those with limited life expectancy, patients in whom there are multiple prior failed AV accesses with no available options due to a combination of inflow artery and outflow vein problems (eg, severe arterial occlusive disease, noncorrectable central venous outflow occlusion) or in pediatric patients with vessels of prohibitively diminutive caliber [5]. In addition, tunneled dialysis catheters may be placed for long-term use in patients with a valid preference, whereby use of an AV access would considerably restrict quality of life or attainment of life goals. This is advocated only after the patient has been properly informed of patient-specific risks and benefits of other potential and reasonable access options that specifically apply to them [5].
Dialysis Fistula Malfunction. The KDOQI 2019 guidelines suggest that placement of a tunneled (cuffed) dialysis catheter is a valid option, supported by the goal of hemodialysis access use for limited duration (eg, <3 months) [5]. In such cases, when AV access is expected to be ready for use in the short term, it is preferred to place tunneled dialysis catheters in the extremity opposite to the extremity that is anticipated for AV access creation or revision. The KDOQI experts tout that in urgent dialysis initiation (eg, <1 month), a tunneled cuffed femoral CVC may be acceptable until the AV access is created and usable. The option to use the femoral vein allows for preservation of upper extremity vasculature for the pending AV access creation. The KDOQI 2019 guidelines regards it as reasonable to place a tunneled dialysis catheter for a long term or indefinite duration in those with limited life expectancy, patients in whom there are multiple prior failed AV accesses with no available options due to a combination of inflow artery and outflow vein problems (eg, severe arterial occlusive disease, noncorrectable central venous outflow occlusion) or in pediatric patients with vessels of prohibitively diminutive caliber [5]. In addition, tunneled dialysis catheters may be placed for long-term use in patients with a valid preference, whereby use of an AV access would considerably restrict quality of life or attainment of life goals. This is advocated only after the patient has been properly informed of patient-specific risks and benefits of other potential and reasonable access options that specifically apply to them [5].