Antithrombotic measures for indwelling intravenous haemodialysis catheters—Columbus' egg yet to be found

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Abstract
Few expressions are used more often in haemodialysis literature than that vascular access is essential for adequate extracorporeal renal replacement therapy. In the absence of an arteriovenous access site it is common practice to use indwelling venous catheters, usually inserted in the jugular, femoral or subclavian vein. Scribner shunts appear to be used much less frequently than in the early years of dialysis. Usually catheters contain a single or double lumen, are cuffed or non-cuffed to help prevent catheter-related infection, and consist of polyurethane, polyethylene or silicone, the latter being more flexible and less thrombogenic, at least in the laboratory. While dialysis via these catheters may be less effective than dialysis via a native fistula or graft because of recirculation, the main concern for nephrologists treating their patients via an intravascular catheter are complications associated with the insertion and residence of these catheters, the latter including infection, thrombosis and stenosis of central veins. Complications and malfunction of indwelling catheters carry the burden of considerable loss of efficiency of treatment, financial expenses and patient morbidity and mortality.