Catheter Placement Duration Guidelines

Duration Guidelines by Catheter Type and Location

Femoral catheters should not remain in place longer than 5 days and should only be used in bed-bound patients with good exit-site care, as recommended by the American Journal of Kidney Diseases 1, 2, 3
Internal jugular noncuffed catheters should not be used for more than 1 week due to increasing infection risk, according to the American Journal of Kidney Diseases 3, 4
Beyond 1 week, infection rates increase exponentially for noncuffed catheters, as reported by the American Journal of Kidney Diseases 4, 5
Tunneled cuffed catheters are preferred for longer durations of hemodialysis therapy over noncuffed catheters due to lower infection rates, as stated by the American Journal of Kidney Diseases 3, 4
Umbilical artery catheters should optimally not be left in place more than 5 days, as recommended by the Clinical Infectious Diseases journal 6
Umbilical venous catheters can be used up to 14 days if managed aseptically, according to the Clinical Infectious Diseases journal 6
In adults, replace short peripheral venous catheters at least every 72-96 hours to reduce phlebitis risk, as recommended by the MMWR Recommendations and Reports 7

Noncuffed catheter infection rates are more than 5 times greater with internal jugular catheters and almost 7 times greater with femoral catheters compared to tunneled cuffed catheters, as reported by the American Journal of Kidney Diseases 4, 5
Monitor for signs of exit site infection, tunnel tract infection, or systemic infection, as recommended by the American Journal of Kidney Diseases 1, 8
Any sign of infection should prompt removal of noncuffed catheters, according to the American Journal of Kidney Diseases 1, 8

The American Journal of Kidney Diseases recommends that the right internal jugular vein is preferred for catheter placement due to direct route to caval atrial junction and lower complication risk 2
Avoid subclavian vein catheterization due to risk of central venous stenosis, as recommended by the American Journal of Kidney Diseases 2, 5
Femoral catheters should be at least 19 cm long to minimize recirculation, as stated by the American Journal of Kidney Diseases 3, 4

Remove catheters as soon as possible when no longer needed, as recommended by the MMWR Recommendations and Reports 7
Use tunneled cuffed catheters for anticipated longer durations of catheterization, according to the American Journal of Kidney Diseases 3, 4
Leaving femoral catheters in place for more than 5 days in non-bed-bound patients should be avoided, as recommended by the American Journal of Kidney Diseases 1, 3
Failing to monitor for signs of infection should be avoided, as stated by the American Journal of Kidney Diseases 1, 8
Discharging patients with noncuffed catheters due to risks of infection, inadvertent removal, and hemorrhage should be avoided, according to the American Journal of Kidney Diseases 4, 5
Using subclavian vein for catheter placement in patients who may need permanent vascular access should be avoided, as recommended by the American Journal of Kidney Diseases 2, 5

Tunneled cuffed catheters can provide access over a period of months, improving chances of arteriovenous fistula maturation in patients who require immediate hemodialysis, according to the American Journal of Kidney Diseases 9, 10
Tunneled cuffed catheters have a longer expected use-life than non-cuffed catheters but still shorter than arteriovenous fistulas or grafts, as reported by the American Journal of Kidney Diseases 9, 10

The right internal jugular vein is the preferred site for permanent catheter placement due to its direct route to the caval atrial junction and lower complication rates, as recommended by the American Journal of Kidney Diseases 10
Subclavian access should be avoided when possible due to the risk of central venous stenosis, especially in patients who may need permanent vascular access in the future, according to the American Journal of Kidney Diseases 10

Infection is a major complication limiting the duration of catheter use, as reported by the American Journal of Kidney Diseases 9, 10
Exit site, tunnel tract, or systemic infections should prompt removal of the catheter, according to the American Journal of Kidney Diseases 11

Thrombotic complications can manifest as catheter malfunction or symptoms of deep vein thrombosis, as described by the Journal of the American College of Radiology 12
The overall incidence of catheter-related deep vein thrombosis ranges from 27% to 66% (asymptomatic) and 0.3% to 28.3% (symptomatic), as reported by the Journal of the American College of Radiology 12

Fluoroscopy is mandatory for insertion of all cuffed dialysis catheters to ensure optimal catheter tip position, as recommended by the American Journal of Kidney Diseases 10
The catheter tip should be positioned at the level of the caval atrial junction or into the right atrium to ensure optimal blood flow, according to the American Journal of Kidney Diseases 10
Real-time ultrasound-guided insertion is recommended to reduce insertion-related complications, as suggested by the American Journal of Kidney Diseases 10

Plan for more permanent access options (arteriovenous fistula or graft) while using the catheter, as recommended by the American Journal of Kidney Diseases 9, 10