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Intracardiac access for hemodialysis: A case series

Maintenance of functioning vascular access has long been recognized as the Achilles heel of a patient undergoing hemodialysis (HD). A subset of patients on HD for endstage renal disease (ESRD) may progressively exhaust all forms of traditional vascular access. In these patients, exploration of nontraditional HD access sites becomes imperative and life saving. Although various nontraditional approaches exist to obtain emergent vascular access, the benefits of direct intracardiac catheters over others include the ability to use standard cuffed catheters, and the ability to function despite thrombosis or stenosis of the central venous system and vena cava. Since 2003, 3 patients with ESRD at our institution exhausted their traditional dialysis vascular access options. All 3 were not suitable candidates for peritoneal dialysis. Emergent and successful implantation of right atrial dialysis catheters was achieved in all patients, providing functioning HD access in a desperate situation.