Hemodialysis catheter placement: What should you know?

Develop a fundamental understanding of venous anatomy, including supradiaphragmatic and infradiaphragmatic systems, normal variants and acquired abnormalities, to safely place central venous catheters and recognize misplacement risks.

Prioritize supradiaphragmatic venous access for hemodialysis, especially the right internal jugular vein, using ultrasound guidance to minimize complications and preserve future AV fistula options.

Master ultrasound fundamentals for venous access and central venous catheter placement, including probe types, frequency, gain, depth, color flow, pulse wave, focus, and transducer motions.

Master the essential tools for dialysis catheter placement, including ultrasound, fluoroscopy, and a complete kit with catheters, needles, wires, and contrast, plus notes on sedation and balloon readiness.

Perform sterile, ultrasound-guided access for hemodialysis catheter placement. Align catheter length, cuff position, and exit site to ensure proper tip placement and minimize infection risk.

Understand how central venous hemodialysis catheters function, how tip design and position affect flow, and how to identify early vs late dysfunction and management.

Perform catheter replacements to preserve uninterrupted hemodialysis access, using over-the-wire exchanges and fluoroscopic guidance to address dysfunctions such as fibrin sheath and infection, with axis preservation.

Explore central venous occlusions and stenosis from long-term catheter use, fibrin sheath, and device-related inflammation, and learn customized recanalization with balloon dilation, selective stent use, and cost considerations.

Examine extreme access options for hemodialysis catheters when central veins are occluded, including trans lumbar, trans renal, and transhepatic routes with imaging guidance to preserve venous pathways.

As catheter placements increase, misplacement and complications rise; understand normal and variant venous anatomy, review prior images, and recognize infection, thrombosis, stenosis, and extravasation risks.