Abstract
Background:
Tunneled central venous catheters (TCVCs) remain an important component of hemodialysis vascular access despite recognized complications including infection, thrombosis, and catheter dysfunction. Although multiple catheter designs and technologies are available, there is limited comparative evidence supporting the use of one catheter type over another. Current KDOQI vascular access guidelines acknowledge this lack of evidence and recommend that catheter selection should rely on clinician judgment. This study aimed to explore how clinicians select dialysis catheters in routine practice and identify factors influencing decision-making.
Methods:
A standardized questionnaire was developed to capture clinician perspectives regarding dialysis catheter use. The survey was distributed internationally using SurveyMonkey via QR codes and web links through professional networks including the Vascular Access Society and the Dialysis Catheter Collaborative. Participation was voluntary and anonymous. The survey was open between January and March 2026. Questions addressed respondent characteristics, practice setting, catheter insertion volume, factors influencing catheter selection, perceived complications limiting catheter lifespan, confidence in current catheter technologies, and priorities for future research. Responses were analyzed descriptively.
Results:
A total of 111 clinicians from 37 countries responded. Participants included nephrologists/interventional nephrologist (n = 47; 42.3%), vascular surgeons (n = 44; 39.6%), interventional radiologists (n = 15; 13.5%). Catheter performance (63%), availability (42.3%), and ease of insertion (39.6%) were the most frequently cited factors influencing catheter choice. Thrombosis or fibrin sheath formation was considered the complication most often limiting catheter lifespan (52.3%), followed by infection (29.7%). Confidence in current catheter technologies to prevent complications was generally moderate to low.
Conclusions:
Dialysis catheter selection is primarily influenced by practical considerations rather than strong comparative evidence. These findings highlight a substantial evidence gap and support the need for robust comparative clinical studies to guide catheter choice and improve outcomes for patients requiring TCVC.
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Supplementary Material
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