Table 1.

Prevention and management of catheter dysfunction

Choice of the dialysis catheters
Materials	Silicone or polyurethane catheter
	Heparin coated catheters are not recommended
Diameters	12- to 16-French (4–5 mm)
Length	For the upper sites: at least 15 cm to obtain right atrium placement for soft DC, superior vena cava for rigid DC
	For the lower sites: probably at least 24 cm
Lumens	Dual lumen catheter
	Two single-lumen catheters less easy to place but at least as accurate as dual lumen catheters
Tunnelization	Lower rate of DC dysfunctions but placement more difficult
Choice of the insertion site
	Femoral and right jugular sites better than left jugular site
	Right internal jugular site should be preferred in intermittent hemodialysis if QB has to be higher than 200 ml/min
	Subclavian sites to be avoided
	Ultrasound guidance especially for jugular sites
	Preserve vascular network
Positioning of the catheter
Upper sites	Tips of the catheter placed next to the right atrium in the superior vena cava
	Check chest radiography
Lower sites	Tips of the catheter placed in the inferior vena cava
During renal replacement therapy (RRT)
Flush	Use saline solution flushes before and after every RRT session
Pressure	Check pressure greater than −250 mmHg on the inflow site
	Check pressure <250 mmHg on the outflow site
Lock	Anticoagulant lock, i.e., heparin after every RRT
Clamp	Careful clamp closing after every RRT
In case of dysfunction
Patient	Try to change patient position
Flush	Try to flush catheter lumens with saline solutions
Catheter	Try to rotate the catheter
Lumens	Try to reverse catheter lumens. Prolonged port reversal not recommended due to recirculation which compromises efficacy
Locks	Fibrinolytic locks are not evaluated and are not yet recommended
Dose of RRT	Check previous KT/V in case of intermittent hemodialysis session and consider catheter replacement
Education of the team