Seminars in dialysis
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Seminars in dialysis · May 2007
ReviewFluid mechanics and clinical success of central venous catheters for dialysis--answers to simple but persisting problems.
Over 60% of patients initiating chronic hemodialysis in the United States have a chronic central venous catheter (CVC) as their first blood access device. Although it would be better if these patients started dialysis with fistulas, the CVC is used because it is a reliable and relatively safe method for obtaining blood access over a period of months. Drawing blood from a vein at 300-400 ml/minute is a relatively delicate and somewhat unpredictable process, and there is always a tendency for the vein wall to draw over the arterial tip and obstruct flow. ⋯ Which is really better, splitsheath or over-the-wire placement? 10. Which dialysis access has a lower complication rate--CVC or arteriovenous (AV) graft? There remain important problems with CVC for dialysis. With a few more improvements, chronic CVC for dialysis could become a painless, effective and safe long-term access for the majority of dialysis patients and acceptable as an alternative to AV grafts.