From the Guidelines
Contraindications to dialysis catheter placement include active bacteremia or sepsis, severe coagulopathy that cannot be corrected, lack of appropriate venous access, and local infection at the intended insertion site, as these conditions increase the risk of complications such as infection, bleeding, and vascular injury 1. When considering dialysis catheter placement, it is essential to evaluate the patient's overall condition and potential risks.
- Active bacteremia or sepsis is a significant contraindication, as it increases the risk of catheter-related bloodstream infections (CRBSI) 1.
- Severe coagulopathy, such as thrombocytopenia (platelet count <20,000/μL) or INR >1.8, should be corrected before the procedure to minimize the risk of bleeding complications 1.
- Lack of appropriate venous access, such as previous venous thrombosis or stenosis, may make catheter placement technically challenging and increase the risk of complications 1.
- Local infection at the intended insertion site is also a contraindication, as it increases the risk of CRBSI and other infectious complications 1. In emergency situations where dialysis is life-saving, some relative contraindications may be overlooked with appropriate precautions and risk mitigation strategies in place, such as transfusing platelets or using fresh frozen plasma to correct coagulopathy 1.
- Relative contraindications include previous venous thrombosis or stenosis at the target site, anatomical abnormalities that make catheter placement technically challenging, and uncooperative patients who cannot remain still during the procedure 1.
- For patients with coagulopathy, platelets can be transfused to achieve counts >20,000-50,000/μL, and fresh frozen plasma or prothrombin complex concentrate may be used to reverse anticoagulation 1. It is crucial to weigh the potential benefits and risks of dialysis catheter placement and consider alternative options, such as arteriovenous fistula or graft, when possible, to minimize the risk of complications and improve patient outcomes 1.
From the Research
Contraindications to Dialysis Catheter Placement
- Thrombosis or stenosis of the central veins is a contraindication to dialysis catheter placement, as it can lead to complications such as painful edema of the arm and exclusion of the arm for future vascular access 2.
- Previous placement of a pacemaker, automatic implantable cardioverter defibrillators, or central line in the ipsilateral jugular vein was thought to be a contraindication, but recent studies suggest that this may not be the case 3.
- Infection is a major complication of dialysis catheters, and patients with a history of catheter-related infection, MRSA-carriage, or bacteremia or bacteriuria in the period of 3 months prior to catheter implantation are at increased risk of developing catheter-related infections 4.
- The presence of diabetes mellitus or immunosuppression does not appear to be a significant risk factor for catheter-related infections 4.
- The subclavian route should be abandoned in chronic uremic patients due to the high risk of thrombosis and stenosis, and the femoral route should be preferred for short-term access while the jugular route could be used for long-term temporary vascular access for hemodialysis 2.
Relative Contraindications
- Malfunctioning catheters may require venography to rule out the presence of significant catheter-related thrombosis 5.
- Patients with catheter-related infections may require catheter removal or revision, rehospitalization, and use of antibiotics 4.