Tunneled dialysis catheter: Simple, re-do, complicated

Tunneled dialysis catheter (TDC) placement plays an essential role in hemodialysis patients. These catheters are inserted in a significant number of patients prior to establishing permanent dialysis access. Insertion is often simple and straightforward, and the preference is to use the right internal jugular vein due to fewer chances of long-term complications. However, significant obstacles exist including upper body central venous occlusions making catheter insertion complicated. In this report, we describe the technique of TDC insertion in the upper body, known complications from long-term TDC insertion, upper body central venous occlusion as an obstacle for TDC placement as well as the solutions available to mitigate this problem. Additionally, we will review techniques to convert TDC into long-term hemodialysis access.