From the Research
It is recommended to avoid placing a dialysis catheter and a central line in the same blood vessel whenever possible, due to the increased risk of complications such as thrombosis, vessel stenosis, and infection, as supported by the most recent study 1. When multiple catheters are needed, they should ideally be placed in separate vessels - for example, a dialysis catheter in the right internal jugular vein and a central line in the left subclavian vein. If multiple access points are absolutely necessary and limited vessel options exist, placement in different locations of the same vessel (with adequate distance between entry points) may be considered, but this should be a last resort. The reasoning behind this recommendation relates to blood flow dynamics and infection risk, as multiple catheters in one vessel can significantly reduce blood flow, increasing thrombosis risk, and each catheter serves as a potential entry point for bacteria, with proximity between lines potentially facilitating cross-contamination, as discussed in 2 and 3. Key considerations for minimizing risks include:
- Using antimicrobial ointments and dressings to prevent catheter-related infections, as outlined in 2
- Implementing proper catheter care and maintenance protocols to reduce the risk of thrombosis and infection, as discussed in 4 and 5
- Regularly assessing catheter function and patency to identify potential issues early, as recommended in 1 When planning vascular access for a patient requiring both dialysis and central venous access, a multidisciplinary approach involving nephrology, vascular access specialists, and critical care teams should guide decision-making to optimize patient outcomes, taking into account the latest evidence and guidelines, such as those presented in 1 and 5.