Tunneled Hemodialysis Catheters: Six Current Questions

This review examines six key questions about tunneled hemodialysis catheters: material selection, tip design, insertion site, optimal tip positioning, fibrin sheath management, and infection prevention. Most modern catheters use polyurethane-polycarbonate copolymers that resist material failure. Symmetric-tip designs reduce dysfunction rates compared to other designs. While the right internal jugular vein is preferred, patient-specific factors should guide insertion site selection. Left-sided catheters benefit from right atrial tip positioning, whereas right-sided catheter tip location is less critical. Fibrin sheaths commonly cause catheter dysfunction, and multiple treatment methods are available, with no clear single best approach. Infection risk is multifactorial, with evidence supporting targeted preventive measures. While catheter materials and designs continue to evolve, individualized management remains essential.