Scientific Publications Database

Article Title: Common errors in temporary hemodialysis catheter insertion
Authors: Samaha, Daniel; Clark, Edward G.
Journal: SEMINARS IN DIALYSIS Volume 32 Issue 5
Date of Publication:2019
Abstract:
Non-tunneled hemodialysis catheter (NTHC) insertion is an essential skill for nephrology practice and remains a requirement of training. However, improper insertion technique can increase the risk of potentially fatal infectious and mechanical complications. Evidence-based strategies can reduce the rates of such complications and should be integrated into practice and training. Ultrasound (US) guidance should routinely be used for NTHC insertion at the femoral and internal jugular sites (with avoidance of the subclavian site). Nephrologists should receive proper training in the use of US for line insertion. With respect to other aspects of the procedure, proper insertion technique readily prevents guidewire-induced arrhythmias. In addition, adherence to infection-control guidelines results in a sustainable reduction in bloodstream infections. All these aspects of NTHC insertion may be best taught and evaluated through a program that includes simulation-based mastery learning (SBML) training. As a separate issue, nephrologists (and intensivists) should be aware that a dysfunctional catheter should be replaced at a new site rather than being changed over a guidewire. This review of common errors related to NTHC insertion seeks to highlight evidence-based approaches to practice and training. The ability to safely and efficiently insert a non-tunneled hemodialysis catheter (NTHC) remains a compulsory skill to be mastered before the completion of nephrology training.(1,2) Over the years, the standard of care for NTHC insertion has changed with the introduction of ultrasound (US)-guided central venous catheter (CVC) placement and infection control bundles.(3-5) However, CVC insertion, including NTHC, involves an inherent risk and is associated with significant morbidity and mortality despite these advances.(6) Moreover, there is increasing evidence that a majority of trainees and attending nephrologists do not meet the passing grade when assessed in a controlled environment,(7) and a third of trainees do not feel competent to insert NTHCs.(8) This is worrisome not only because NTHC insertion remains a mandatory skill, but also because of the potential for devastating or fatal complications. This review focuses on common errors in NTHC placement with the goal of highlighting the importance of adherence to evidence-based techniques and training.