The use of a tunneled permanent catheter as temporary vascular access in arteriovenous graft patients for long-term patency

Background Generally, the preferred route of vascular access in chronic kidney disease patients is an arteriovenous fistula (AVF) rather than grafts. However, approximately 7% of 300,000 Japanese hemodialysis (HD) patients continue to dialyze with grafts. In patients who have arteriovenous grafts (AVGs), complications such as thrombosis, hemorrhaging, and infection are common, resulting in lower graft patency. Therefore, in our hospital, to improve graft patency, cases requiring HD immediately after AVG surgery (vascular access occlusion) undergo placement of a tunneled (cuffed) permanent catheter in the internal jugular vein at the time of AVG creation to eliminate preemptive interventions in grafts at risk for thrombosis, hematoma, and infection. We use a tunneled permanent catheter instead of a nontunneled (noncuffed) temporary catheter because nontunneled temporary catheters often require replacement due to catheter-related bacteremia and thrombotic occlusion before the first cannulation.