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Dialysis catheters in the ICU

selection, insertion and maintenance

Girardot, Thibauta,b; Monard, Célinea,b; Rimmelé, Thomasa,b

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 469–475
doi: 10.1097/MCC.0000000000000543
RENAL SYSTEM: Edited by Thomas Rimmelé
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Purpose of review Choosing the best catheter for renal replacement therapy (RRT) is not an easy task. Beyond catheter length, many of its properties can influence effectiveness of the RRT session. Maintenance between sessions, particularly the locking solution, also impacts catheter lifespan and infection rates.

Recent findings Many innovations in dialysis catheters have been proposed by the industry over the past decade, including the material used, the shape of the lumens and the position of the inflow and outflow holes. Impregnated catheters have also been developed to prevent catheter-related infections. Many locking solutions are available, either for maintaining catheter patency or for preventing infections.

Summary Although studies conducted in the specific context of the ICU are still scarce, some conclusions can be drawn. Catheter length must be adapted to the insertion site to reach an area of high blood flow. Kidney-shape lumens appear to be less thrombogenic and seem to prevent catheter dysfunction. Catheter tip and lumen holes also affect catheter function. For catheter locking, 4% citrate appears nowadays as one of the best options, but taurolidine-based solutions are also interesting.

aAnesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon

bEA 7426 ‘Pathophysiology of Injury-Induced Immunosuppression’ – PI3, Hospices Civils de Lyon – Biomérieux – University Claude Bernard Lyon 1, Lyon, France

Correspondence to Thomas Rimmelé, MD, PhD, Département d’Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69003 Lyon, France. Tel: +33 4 72 11 69 88; fax: +33 4 27 85 80 93; e-mail: thomas.rimmele@chu-lyon.fr

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