TRANSLUMBAR PLACEMENT OF INFERIOR VENA-CAVAL CATHETERS - A SOLUTION FOR CHALLENGING HEMODIALYSIS ACCESS

Access to the central venous circulation for hemodialysis has traditio nally been achieved via the subclavian or jugular venous routes, With ongoing improvements in medical management, many hemodialysis recipien ts develop exhaustion of these routes and require alternative means of central venous access, inferior vena caval (IVC) catheters have been placed with a percutaneous translumbar approach to allow central venou s access for chemotherapy, harvesting of stem cells, and total parente ral nutrition, Translumbar placement of IVC catheters has become accep ted by some as a useful and reliable alternative in patients who requi re long-term hemodialysis but have exhausted traditional access sites, IVC catheters have been placed in patients with IVC filters, and IVC filters have been placed in patients with IVC catheters, Complications include those associated with central venous catheters, for example, sepsis, fibrin sheaths, and thrombosis, A complication specific to pla cement of IVC hemodialysis catheters is migration of the catheter into the subcutaneous soft tissues, retroperitoneum, or iliac veins, Trans lumbar placement of IVC catheters is performed only in patients consid ered to have few or no other medical options and is not intended as a primary means of central venous access.