Vascular Access Management Research Articles

Estudio de eventos adversos, factores y periodicidad en pacientes hospitalizados en unidades de cuidado intensivo

Objetivo: Determinar los eventos adversos (EA) reportados por enfermería y sus factores en unidades de cuidado intensivo (UCI) adulto, pediátrica o neonatal de tres países participantes (México, Argentina y Colombia). <br /><br />Método: Se desarrolló un estudio multicéntrico, descriptivo, correlacional. La unidad de observación la constituyeron los EA reportados por enfermería durante un periodo de seis meses en 17 UCIS. Para el reporte se diseñó un formulario digital, presentado en línea, que contenía las categorías y los factores relacionados de los Eventos Adversos. La información se analizó con el programa estadístico SPSS Statistics 22.0, versión 2013.<br /><br />Resultados: Se reportaron 1163 eventos, de los cuales el 34 %, se relacionó con el cuidado, el 19 % con vía aérea y ventilación mecánica, el 16 % con el manejo de accesos vasculares y drenajes, el 13 % con infección nosocomial y el 11 % con la administración de medicamentos. El 7 % restante correspondió a relacionados con pruebas diagnósticas y equipos. El 94,8% se consideraron prevenibles. Para determinar los factores presentes en los EA, se utilizó el coeficiente Phi y se encontró que los que podrían estar relacionados fueron aquellos del sistema en los que predominó la falta de adhesión a protocolos, problemas de comunicación, formación y entrenamiento inadecuado (Phi 0-1 p<0,05). <br /><br />Conclusiones: Los EA con mayor prevalencia están relacionados, en su mayoría, con el cuidado directo al paciente y el de vía aérea. El posible factor relacionado fue el del sistema. Por tal motivo, el profesional de enfermería debe establecer estrategias para fortalecer y mejorar los procesos relacionados con la aplicación de protocolos, comunicación y una política de recursos humanos. <br /><br />

What Does Early Mean? Remarks on Immediate Prosthetic Vascular Access Cannulation for Urgent Hemodialysis

Management of complicated vascular access. A step-by-step description of a case of hyperkalemia and vascular access failure in a patient receiving maintenance hemodialysis treated for numerous previous stenosis and thrombosis of the native vascular access. The discussion revolves around the following key questions: 1. Basilic vein thrombosis and re-stenosis, what do you think it should be done after this complication? 2. Venous back bleeding was satisfactory; do you think thrombectomy was effective? 3. We thought that central vein stenosis stenting was needed, wasn't it? 4. What do you think about basilic stenosis? The patient had undergone multiple recent basilic angioplasties. Consequently, a surgical intervention could have been definitive. Various surgical options were possible. But first of all, we had to solve a dilemma: The patient had received multiple previous central vascular catheters; our aim was to avoid a new central vascular access placement. At the same time, we required a vascular access for prompt cannulation. Do you think that was a real problem? Do you agree with us, or in the present circumstance, would you have preferred a central venous device? 5. Finally, we decided in favor of creation of a prosthetic vascular access. We chose a graftspecifically designed for early cannulation. Do you agree with us? Do you think early cannulation could cause a worse vascular access outcome? 6. Patient underwent last hemodialysis (HD) 24 hours before surgery. Consequently we trusted that the next HD could be delayed for at least 24 hours. Unfortunately, intraoperative arterial blood gas analysis documented hyperkalemia and acidosis. Our nephrologist suggested HD. In your opinion what does “early” mean?.

CARE OF A PATIENT'S VASCULAR ACCESS FOR HAEMODIALYSIS: A NARRATIVE LITERATURE REVIEW.

Patients requiring haemodialysis have diverse clinical needs impacting on the longevity of their vascular access and their quality of life. A clinical practice scenario is presented that raises the potential of unsafe cannulation of a patient's vascular access as a result of minimal patient empowerment. Vascular access care is the responsibility of everyone, including the patient and carer. The aim of this narrative literature review (1997-2014) is to explore the current understanding of what factors influence the care of vascular access for haemodialysis. A narrative literature review allows the synthesis of the known literature pertinent to the research question into a succinct model or unique order to enable new understandings to emerge. The bio-ecological model was used to guide the thematic analysis of the literature. The narrative literature review revealed five themes related to care of vascular access: patient experience; relationships-empowerment and shared decision making; environment of healthcare; time; and quality of life as the outcome of care. The management of vascular access is complicated. Current available literature predominantly concentrates on bio-medical aspects of vascular access care. Contextualised vascular access care in the complex ecology of the patient and carer's lives has the potential to enhance nursing practice and patient outcomes.

Paediatric vascular access

### Key points Obtaining reliable vascular access in small children is frequently made challenging by anatomical factors—in particular, small, mobile veins and an excess of subcutaneous fat which make visualization and palpation of veins difficult. Paediatric patients are often less co-operative, and the potential for psychological trauma, especially with repeated procedures in the conscious patient, further complicates matters. Short-term vascular access is frequently required in hospitalized children for the delivery of i.v. fluids, medication, and blood product administration. Longer-term vascular access devices are required for repeated medication delivery (e.g. enzyme replacement therapy in inherited metabolic diseases), chemotherapy, immunotherapy, total parenteral nutrition, and extracorporeal procedures such as plasmapheresis and haemodialysis. In addition, vascular access devices may be needed for repeated blood sampling and invasive haemodynamic monitoring. The choice of vascular access device depends upon the condition and preference of the patient or parent/guardian, the likely duration and frequency of treatment, and the properties of the infusate. Infusates with vesicant properties (drugs with the potential to cause blistering with tissue injury, e.g. calcium solutions and amphotericin B), hypertonic solutions, and those with pH 9 will necessitate central venous access. Vasopressors and inotropes are preferentially administered centrally as they require reliable access and extravasation may cause tissue necrosis. It is important to try to predict future needs for vascular access as poor prospective management …

Cardiac Assist Devices and Hemodialysis Catheter Procedures - What Do the Nephrologists Need to Know?

The use of ventricular assist devices (VAD) and total artificial heart (TAH) is increasing rapidly, and a large proportion of these device recipients already have or will develop severe renal dysfunction at the time of device implantation. As a consequence, nephrologists are becoming more and more involved in the care of this challenging population. As nephrologists take upon themselves many aspects of dialysis vascular access care, they need to be familiar with the special circumstances of performing hemodialysis catheter procedures in these patients. This review describes the important characteristics of these devices that have serious implications for the technique of placing or replacing dialysis catheters. These implications apply for both tunneled and nontunneled dialysis catheters and so concern all nephrologists, not only the interventionalists. We describe the important anatomical factors, anticoagulation management, device management, vascular access management and technical considerations of placing or replacing tunneled and nontunneled hemodialysis catheters from the perspective of a nephrologist establishing and maintaining lifesaving dialysis vascular access. Without a good understanding of these devices, serious consequences such as VAD rotor damage or blockage, or artificial heart valve blockage or damage can occur. These artificial devices are lifesaving, and any such complication is unacceptable. This review describes steps to minimize the risks.

Hemodialysis vascular access management in the Netherlands.

In the Netherlands, 86% of patients start renal replacement therapy with chronic intermittent hemodialysis (HD). Guidelines do indicate predialysis care and maintenance of a well-functioning vascular access (VA) as critical issues in the management of the renal failure patient. Referral to the surgeon and time to VA creation are important determinants of the type and success of the VA and HD treatment. Data from a national questionnaire showed that time from referral to the surgeon and actual access creation is <4 weeks in 43%, 4 to 8 weeks in 30% and >8 weeks in 27% of the centers. Preoperative ultrasonography and postoperative access flowmetry are the diagnostic methods in the majority of centers (98%). Most facilities perform rope-ladder cannulation with occasionally the buttonhole technique for selected patients in 87% of the dialysis units. Endovascular intervention for thrombosis is practiced by 13%, surgical thrombectomy by 21% and either endovascular or surgery by 66% of the centers. Weekly multidisciplinary meetings are organized in 57% of the units. Central vein catheters are inserted by radiologists (36%), nephrologists and surgeons (32%). We conclude that guidelines implementation has been successful in particular regarding issues as preoperative patient assessment for VA creation and postoperative surveillance in combination with (preemptive) endovascular intervention, leading to very acceptable VA thrombosis rates.

Predictors of Patency Following Fistulography and Percutaneous Interventions in the Treatment of Nonfunctioning Native Vascular Access

Aim: The aim was to evaluate the various factors predicting patency following fistulography and percutaneous interventions in the management of nonfunctioning native vascular access. Materials and Methods: Retrospective analysis of 61 patients with native arteriovenous fistulae (AVF) who underwent fistulography and percutaneous interventions from January 2010 to December 2013. Mean patient age was 47 (23-78) years. 69% (42 of 61) of the patients were males. 56% (34 of 61) of patients underwent elbow AVF creation, and the remaining were forearm AVFs. Median time from fistula creation to fistulography was 9 months. On fistulography, hemodynamically significant (>50%) stenosis were identified in 93% (57 of 61) of patients. Angioplasty was attempted in 88% (54 of 57) of fistulae. In 14% (8 of 54) of cases, stent was placed. Results: Technical success was achieved in 98% (53 of 54) of fistulae following angioplasty. Clinical success (ability to use the AVF for successful hemodialysis) was noted in 87% (47 of 54) of cases. About 52% (32 of 61) of the fistulae had multiple stenosis. The most common location of stenosis was the venous limb of the fistula (70%). The primary patency rates were 75.4%, 68.9%, and 30% at 3, 6 and 12 months. The secondary patency rates were 100%, 89%, and 70% at 3, 6 and 12 months. The absence of palpable thrill postprocedure was found to be a risk factor for both primary, as well as secondary patency rates. Conclusions: Our results demonstrate that fistulography and percutaneous interventions in the form of angioplasty and stenting are helpful in maintaining the patency of nonfunctioning native vascular access. We found that the most important predictor of fistula patency following percutaneous interventions is the presence of palpable thrill. Our study also showed that stent placement is effective in treating venous stenotic lesions in native arteriovenous fistula hemodialysis patients after unsatisfactory balloon dilatation.

Patients with chronic kidney disease: safety aspects in the preoperative management.

Chronic kidney disease (CKD) is a major public health problem worldwide. Early detection and treatment of CKD can often prevent or delay some of the negative outcomes of CKD. This chapter shows how treatment of hypertension, proteinuria and metabolic disorders slow down the deterioration of renal function. Irrespective of the mode of renal replacement therapy, maintaining the veins in the upper extremities is of vital importance. Below are suggestions on how to protect blood vessels of the upper limbs and when to start preparing for the construction of vascular access. In this chapter, it is also shown how necessary it is to conduct a clinical evaluation of the blood vessels, which is required before the start of vascular access management. The methodology of noninvasive evaluation of vessels by duplex sonography is also presented. This method is very useful, especially if the vessels are not clinically visible, as well as the information concerning the morphological and functional properties of blood vessels.

Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice Guideline

BackgroundOur aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs) for central vascular access device (CVAD) insertion, management, and removal in King Saud University Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology of creating the policy document was not evidence-based, and the clinical content was not up to date. A new CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices. MethodsThe King Saud University Medical City CPG Committee introduced the modified ADAPTE process methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration. ResultsThe final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses Society CPG recommendations. In addition, the team developed new implementation tools. ConclusionsThe ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical performance improvement. It can be further adapted according to the local context and resources to promote a sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide accreditation processes and local benchmarking of health care quality outcomes.

Resultados de intercambio plasmático en síndrome del hombre rígido: experiencia de un caso

En las últimas décadas la aféresis terapéutica se ha consolidado como procedimiento de depuración sanguínea integrándose en las unidades de nefrología, ya que precisa de un personal entrenado en el manejo del acceso vascular y requiere amplios conocimientos de la circulación extracorpórea y de sus complicaciones1. La plasmaféresis es un procedimiento terapéutico que tiene como principal objetivo eliminar de la sangre aquellos componentes considerados responsables patógenos de una enfermedad y de este modo contribuir a su tratamiento. La técnica consiste en pasar la sangre del paciente a través de un dispositivo extracorpóreo encargado de separar el plasma de los otros componentes de la sangre, eliminando el plasma separado y reemplazándolo en la proporción 1/1 con albúmina al 5% o plasma fresco congelado2.

Consumer Moments of Truth In the Digital Context

Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

Which Cannulation Technique for Which Patient

Cannulation of arteriovenous (AV) access is a crucial part of vascular access management in hemodialysis patients. It can significantly affect survival of the AV access, and consequently, it probably influences patient survival. The best type of cannulation technique, rotating site versus constant site (or buttonhole), is currently debated, but the increase in infectious complications observed with the buttonhole technique suggests a prudent use of this technique, restricting it to specific patients. Even in cases with a specific indication, the balance between advantages of the constant site needling and the potentially severe consequences of access related systemic infection should be considered. Educational efforts in improving cannulation skills of dialysis staff are important for improving outcomes, as the proper use of the rotating site technique might still be the best approach to cannulation.

Vascular access management and education for hemodialysis patients

Appropriate management and care of vascular access are very important to hemodialysis patient care. Access is the cornerstone of hemodialysis therapy. Vascular access with good function and few complications not only promotes hemodialysis therapy success but also facilitates the ability of patients to restore normalcy to life. Proper vascular access maintenance requires good cooperation between medical care personnel and patients. Nurses are responsible to apply their professional knowledge and technology in clinical practice and educate and encourage patients to take care of themselves. Patients are responsible to apply learned self-care knowledge to their daily life. Such cooperation is essential to enhancing the effectiveness of comprehensive care. This article provides an overview of vascular access issues in hemodialysis therapy, including related nursing assessment, management, and proper cannulation procedures. Enhancing patient self-care abilities and working together with patients on proper vascular access care can prolong vascular access site viability.

Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.

Novel paradigms for dialysis vascular access: upstream hemodynamics and vascular remodeling in dialysis access stenosis.

Failure of hemodialysis access is caused mostly by venous intimal hyperplasia, a fibro-muscular thickening of the vessel wall. The pathogenesis of venous neointimal hyperplasia in primary arteriovenous fistulae consists of processes that have been identified as upstream and downstream events. Upstream events are the initial events producing injury of the endothelial layer (surgical trauma, hemodynamic shear stress, vessel wall injury due to needle punctures, etc.). Downstream events are the responses of the vascular wall at the endothelial injury that consist of a cascade of processes including leukocyte adhesion, migration of smooth muscle cells from the media to the intimal layer, and proliferation. In arteriovenous fistulae, the stenoses occur in specific sites, consistently related to the local hemodynamics determined by the vessel geometry and blood flow pattern. Recent findings that the localization of these sites matches areas of disturbed flow may add new insights into the pathogenesis of neointimal hyperplasia in the venous side of vascular access after the creation of the anastomosis. The detailed study of fluid flow motion acting on the vascular wall in anastomosed vessels and in the arm vasculature at the patient-specific level may help to elucidate the role of hemodynamics in vascular remodeling and neointimal hyperplasia formation. These computational approaches may also help in surgical planning for the amelioration of clinical outcome. This review aims to discuss the role of the disturbed flow condition in acting as upstream event in the pathogenesis of venous intimal hyperplasia and in producing subsequent local vascular remodeling in autogenous arteriovenous fistulae used for hemodialysis access. The potential use of blood flow analysis in the management of vascular access is also discussed.

A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation: The milan experience

To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4% vs. 7.9%, P = 0.258 and 0% vs. 7.9%, P = 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P = 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P = 0.168 and 13.6% vs. 22%, P = 0.315). In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT.

Management of Vascular Access in Transcatheter Aortic Valve Replacement: Part 2: Vascular Complications

The interventional cardiologist must be able to recognize and manage potential vascular complications. Iliofemoral complications are the most frequent vascular complications in transfemoral transcatheter aortic valve implantation. Small vessel dimensions, moderate or severe calcification, and center experience are the major predictors. The traditional treatment for injured arteries has been surgical reconstruction, but endovascular techniques may allow for less invasive but effective management of arterial injuries. Dissection may be treated with prolonged balloon inflation or deployment of a self-expanding or balloon-expandable stent or a surgical graft. Iliofemoral rupture is a serious complication that may lead to retroperitoneal bleeding that can be unrecognized. Rapid insertion of a dilator or sheath or an occlusive balloon is used to achieve hemostasis. Prolonged balloon inflation or implantation of a covered stent or surgical repair should then be considered. Treatment options for failed percutaneous closure include prolonged manual compression, balloon angioplasty, stent implantation, and surgery. Aortic complications are rare, but serious complications are associated with a high mortality rate, even if emergent surgery is performed. There are specific vascular complications associated with alternative access routes such as transapical and transaxillary and direct aortic access.

Dialysis Vascular Access and Lean Management

Vascular access (VA) is the key point to obtain an efficient dialysis, since VA dysfunction can hinder efficacy by increasing costs and hospitalization time, and by worsening quality of life. Costs of VA are increasing, due to the development of new grafts, catheters, and stents, and the increasing number of old patients. A global strategy to contain costs in this field requires a solid and consistent strategy of process management. The Toyota Production System could offer a method to analyze VA from a patient-oriented point of view, by means of identifying wastes and value stream during the process. Vascular burden of at-risk patients (chronic disease, frequent hospital stay) must be protected by skilled nurses. Late referral must be constrained to low figures by controlling the territory and allowing the planning of internal native VA. Residual CVC must be evaluated for AVF conversion, and a hierarchy among AVF, AVG and CVC must be established and respected. Finally, angioplasty and stents must be used in selected cases. CVC appear to be the main waste, while AV fistula is the access with maximum added value. Such a complex activity, involving many professionals, fits very well with a low volume/high quality industry model, and is based on the empowerment of each professional along the production chain. The multi-professional model requires a coordinator able to guide the patient along a pathway composed by the classical steps of planning, monitoring, clinical discussion, and corrective measures. It is our opinion that a senior nurse could be the right professional to do this job, as suggested by the model implemented in organ transplantation.

Vascular Access for Intensive Maintenance Hemodialysis: A Systematic Review for a Canadian Society of Nephrology Clinical Practice Guideline

Practices in vascular access management with intensive hemodialysis may differ from those used in conventional hemodialysis. We conducted a systematic review to inform clinical practice guidelines for the provision of intensive hemodialysis. Adult patients receiving maintenance (>3 months) intensive hemodialysis (frequent [≥5 hemodialysis treatments per week] and/or long [>5.5 hours per hemodialysis treatment]). We searched EMBASE and MEDLINE (1990-2011) for randomized and observational studies. We also searched conference proceedings (2007-2011). (1) Central venous catheter (CVC) versus arteriovenous (AV) access, (2) buttonhole versus rope-ladder cannulation, (3) topical antimicrobial cream versus none in buttonhole cannulation, and (4) closed connector devices among CVC users. Access-related infection, survival, hospitalization, patency, access survival, intervention rates, and quality of life. We included 23, 7, and 5 reports describing effectiveness by access type, buttonhole cannulation, and closed connector device, respectively. No study directly compared CVC with AV access. On average, bacteremia and local infection rates were higher with CVC compared with AV access. Access intervention rates were higher with more frequent hemodialysis, but access survival did not differ. Buttonhole cannulation was associated with bacteremia rates similar to those seen with CVCs in some series. Topical mupirocin seemed to attenuate this effect. No direct comparisons of closed connector devices versus standard luer-locking devices were found. Low rates of actual or averted (near misses) air embolism and bleeding were reported with closed connector devices. Overall, evidence quality was very low. Limited direct comparisons addressing main review questions, small sample sizes, selective outcome reporting, publication bias, and residual confounding were major factors. This review highlights several differences in the management of vascular access in conventional and intensive hemodialysis populations. We identify a need for standardization of vascular access outcome reporting and a number of priorities for future research.

Abstract No. 287 - Ultrasound guided transhepatic permanent dialysis catheter: alternative approach for haemodialysis

Purpose Nonconventional image-guided percutaneous catheter placements are the exception and are requested only when traditional access sites are unavailable. They are good alternative routes for permanent venous access and haemodialysis, and with proper technique and care, will be associated with minimal post procedural complications This study highlights the technical aspects of ultrasound-guided transhepatic permanent dialysis catheter in vascular access management. Materials and Methods For patients dependent on permanent venous catheters for survival, the progressive loss of venous access sites should prompt a systematic approach to alternative sites and techniques to maximize patient survival and minimize complications. Results This study included 12 patients with exhausted all classical venous access for haemodialysis. They had normal coagulation profile. Conscious sedation was used for all patients. Ultrasound guided was used to access the hepatic vein ( right hepatic vein in 8 patients and middle hepatic vein in 4 patients), using a 16 G teflon coated needle. The subcostal approach was selected in 6 patients and the intercostal anterior axillary line in another 6 patients. Under fluoroscopy, the hydrophilic guide wire 0.0035 inch is introduced through the needle in hepatic vein to reach the superior vena cava. Gradual dilatation of the track was performed until peel away sheath was advanced to the cavo-atrial junction. A subcutaneous tunnel was formed and the permanent haemodialysis catheter was inserted with its tip at the right atrium. Mild right hypochondrial pain was noticed in three patients , with intercostal approach, for few days. Follow up for 6 -12 months, revealed normal functioning haemodialysis catheter in 11 patients and a single sepsis complication. Conclusion Transhepatic insertion of haemodialysis catheter is a good non-classical alternative access and has same patency rate and incidence of complications as that of classical chest haemodialysis catheter. Interventional radiologists should be familiar with the appropriate use of both conventional and unconventional types of venous access and their associated risks