Contraindications for Hemodialysis Access

Absolute Contraindications

The American Society of Nephrology states that lack of any viable vascular access sites is an absolute contraindication for hemodialysis access, necessitating consideration of peritoneal dialysis or conservative management 1
Active systemic infection with bacteremia is a temporary contraindication for permanent access creation, particularly until the infection is controlled 2

The National Kidney Foundation recommends that femoral vein CVC placement is contraindicated in patients with femoral or iliac vessel pathology, prior surgery or reconstruction, chronic unresolved diarrhea, morbid obesity, or anticipated kidney transplant 3, 4
Subclavian vein catheterization should be avoided when future arteriovenous fistula or graft is planned, as it carries a high risk of central venous stenosis that can preclude permanent access creation 2, 3, 4
Severe cardiovascular disease may influence access selection, with high-output heart failure potentially contraindicating high-flow AVF creation, and severe peripheral vascular disease limiting distal access options 2, 3, 5
Limited life expectancy or severe comorbidities make long-term catheter use more acceptable despite higher complication rates, particularly in patients with severe congestive heart failure or extensive peripheral vascular disease 5, 6
Anatomic limitations, such as inadequate vessel size or quality, prior central venous stenosis, or extensive prior surgeries or trauma, can preclude specific access types 2, 3, 4

For urgent dialysis need, the American College of Physicians recommends tunneled cuffed catheter in internal jugular vein, avoiding subclavian 3, 4
For anticipated long-term hemodialysis, the Kidney Disease Outcomes Quality Initiative suggests planning for permanent AVF or AVG 3, 4
For short-term need with transplant planned, the American Society of Transplant Surgeons recommends femoral catheter to preserve upper extremity vessels 3, 4

Using subclavian catheters when permanent access is planned can cause central stenosis in up to 50% of cases and eliminate future ipsilateral AVF/AVG options, as warned by the Society of Interventional Radiology 2, 3
Discharging patients with non-cuffed catheters is associated with increased infection risk, hemorrhage risk, and patient safety concerns, according to the Centers for Disease Control and Prevention 6
Creating high-flow AVF in patients with borderline cardiac function can precipitate high-output heart failure, as cautioned by the American Heart Association 5
Ignoring the "distal first" principle can eliminate future distal access options when the proximal access fails, as emphasized by the Vascular Access Society 3, 4
Prolonged catheter use without addressing permanent access is associated with increased mortality risk and higher infection and hospitalization rates, as reported by the National Institutes of Health 2