Central venous catheters for hemodialysis. Cases of failure: Role of the nephrologist

Central venous catheter for chronic hemodialysis can present primary or secondary dysfonctions. The first are related to malpositions or kinking, diagnosis is radiological. A postoperative chest radiography has to be done, but during the first session an initial evaluation of the catheter fonctioning is useful: a 'pressions test' (recording of arterial depression and venous counterpression for progressively increasing blood flow) and recirculationg test have to be performed. Later, clotting or thrombosis of catheter are often involved, detection and managment are different according to the type of manifestations and to the moment of occurrence (when aspiration of residual heparin or when iniating dialysis). Fibrinolytics are often used. Catheter fissuration and leak are also frequent, often on the external extremity of adaptator, occasionally on the proximal extremity, exceptionally on the catheter itself. Managment is according to location of the fissuration, but there are always infectious and hemorragic risks during manipulations and changing of the external adaptator. Prevention of these dysfunctions is imperative, it depends on a strict follow-up and good practices.