Acute dialysis catheters.

Acute dialysis catheters are non-cuffed, non-tunnelled catheters used for immediate vascular access. They are primarily used for acute renal failure in bed-bound patients and for short-term use in patients with malfunction of permanent access. Long-term use of acute catheters is not recommended, but does occur with acceptable infection rates in dialysis centers where tunnelled, cuffed catheters are not available. Most acute catheters are made of polyurethane, but silicone catheters are now available with larger lumen sizes capable of delivering blood flow rates over 300 ml/min. Acute catheters should be inserted in the internal jugular or femoral vein under ultrasound guidance to minimize complications. Subclavian catheters cause stenosis, thrombosis, and perforation of vessels. Intermittent catheter malfunction still occurs, particularly for left-sided internal jugular catheters and catheters placed in women. Blood flow may improve with lumen reversal, intraluminal t-PA, or guidewire exchange. Limiting duration of use and dressing catheter exit sites with dry gauze and antiseptic ointments can prevent catheter-related infections.