中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识(第1版)

王玉柱

doi:10.3969/j.issn.1671-4091.2026.04.001

中国血液净化 ›› 2026, Vol. 25 ›› Issue (04) : 265-277. DOI: 10.3969/j.issn.1671-4091.2026.04.001

指南与共识

中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识(第1版)

中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识编写组

作者信息 +

Chinese expert consensus on the insertion, replacement and removal of tunneled cuffed central venous catheters for hemodialysis (1st edition)

Chinese Expert Consensus Writing Group on the Insertion

Author information +

文章历史 +

摘要

中心静脉导管是重要的血管通路类型，其中带隧道带涤纶套中心静脉导管(tunneled cuffed catheter，TCC)应用逐渐广泛，在国内许多单位已开展。但因各单位理念与技术不统一，部分单位置入、更换与拔除时指征把握、操作规范性、操作风险规避等方面存在欠缺，而TCC的置入、更换本身存在高风险，操作不规范可能导致并发症如窒息、TCC功能不良、TCC相关感染等，严重影响患者透析及生命质量；与此同时，尚有很多单位有开展TCC置入、更换、拔除的需求。鉴于此，北京市海淀医院肾内科王玉柱教授组织成立编写委员会，结合循证医学证据及临床实践经验，制定《中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识》(以下简称共识)。本共识系统介绍了带隧道带涤纶套中心静脉导管的置入、更换及拔除的规范化操作流程。希望在本共识指导下，我国带隧道带涤纶套中心静脉导管的置入、更换及拔除技术能够进一步普及、规范并提高，造福广大血液透析患者。

Abstract

Central venous catheter is an important type of vascular access, among which tunneled cuffed central venous catheter (TCC) is increasingly used and has been adopted by many institutions in China. However, due to inconsistencies in concepts and techniques across different institutions, some demonstrate deficiencies in the indications for TCC insertion, replacement, and removal, as well as in procedural standardization and operational risk management. Given that TCC insertion and replacement are inherently high-risk procedures, non-standard practices may lead to complications such as asphyxia, catheter dysfunction, and catheter-related infections, which can severely affect patients' dialysis outcomes and quality of life. Meanwhile, many institutions still require the performance of TCC insertion, replacement, and removal. In view of this, an expert consensus panel established a writing committee to systematically outline standardized oper ating procedures for the insertion, replacement, and removal of tunneled cuffed central venous catheters, integrating evidence-based consensus with clinical experience. It is hoped that under the guidance of this consensus, the techniques for TCC insertion, replacement, and removal in China can be further promoted, standardized, and refined, thereby benefiting a broader population of hemodialysis patients.

导出引用

中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识编写组. 中国血液透析用带隧道带涤纶套中心静脉导管的置入、更换及拔除专家共识(第1版)[J]. 中国血液净化. 2026, 25(04): 265-277 https://doi.org/10.3969/j.issn.1671-4091.2026.04.001

Chinese Expert Consensus Writing Group on the Insertion. Chinese expert consensus on the insertion, replacement and removal of tunneled cuffed central venous catheters for hemodialysis (1st edition) [J]. Chinese Journal of Blood Purification. 2026, 25(04): 265-277 https://doi.org/10.3969/j.issn.1671-4091.2026.04.001

中图分类号： R459.5

参考文献

[1]SOliver MJ, Callery SM, Thorpe KE, et al.Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study[J].Kidney Int, 2000, 58(6):2543-5.
[2]Buetti N, Ruckly S, Souweine B, et al.Risk of infections in intravascular catheters in situ for more than 10 days: a post hoc analysis of randomized controlled trials[J].Clin Microbiol Infect, 2023, 29(9):1200.
[3]Weijmer MC, Vervloet MG, ter Wee PM.Compared to tunnelled cuffed haemodialysis catheters,temporary untunnelled catheters are associated with more complications already within 2 weeks of use[J].Nephrol Dial Transplant, 2004, 19(3):670-677.
[4]Castro V, Farber A, Zhang Y, et al.Reasons for long-term tunneled dialysis catheter use and associated morbidity[J].J Vasc Surg, 2021, 73(2):588-592.
[5]Pride LB, Assaf EJ, West-Livingston LN, et al.Alternatives for exhausted dialysis access[J].Semin Vasc Surg, 2024, 37(4):400-406.
[6]Hall RK, Myers ER, Rosas SE, et al.Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis[J].Clin J Am Soc Nephrol, 2017, 12(6):947-954.
[7]Vachharajani TJ, Agarwal AK, Asif A.Vascular access of last resort[J].Kidney Int, 2018, 93(4):797-802.
[8]王玉柱 .血液净化通路[M]. 北京: 人民军医出版社, 2008.
[9]Heberlein W.Principles of tunneled cuffed catheter placement[J].Tech Vasc Interv Radiol, 2011, 14(4):192-7.
[10]Yaxley J.Haemodialysis catheters - a review of design and function[J].Expert Rev Med Devices, 2022, 19(10):757-762.
[11]Prasad P, Vachharajani TJ. Dialysis Catheter Tip Design and Dysfunction: An Unsolved Challenge[J]. Am J Kidney Dis, 2024, 83(4):429-431.
[12]Dwyer A. Surface-treated catheters--a review[J]. Semin Dial, 2008,21(6):542-6.?.
[13]Gallieni M, Brenna I, Brunini F, et al.Dialysis central venous catheter types and performance[J].J Vasc Access, 2014, 15(Suppl 7):S140-S146.
[14]El Khudari H, Ozen M, Kowalczyk B, et al.Hemodialysis Catheters: Update on Types,Outcomes,Designs and Complications[J].Semin Intervent Radiol, 2022, 39(1):90-102.
[15]中国医院协会血液净化中心分会血管通路工作组.中国血液透析用血管通路专家共识第版[J].中国血液净化, 2019, 18(6):365-381.
[16]Davanzo WJ. Efficacy and safety of a retrograde tunneled hemodialysis catheter: 6-month clinical experience with the Cannon Catheter chronic hemodialysis catheter[J]. J Vasc Access, 2005,6(1):38-44.
[17]Vascular Access 2006 Work Group.Clinical practice guidelines for vascular access[J].Am J Kidney Dis, 2006, 48(Suppl 1):S176-247.
[18]Tal MG, Yevzlin AS.Initial Clinical Experience with a Symmetric Tip Tunneled Hemodialysis Catheter Without Side Holes[J].ASAIO J, 2021, 67(11):1257-1262.
[19]Ling XC, Lu HP, Loh EW, et al.A systematic review and meta-analysis of the comparison of performance among step-tip,split-tip,and symmetrical-tip hemodialysis catheters[J].J Vasc Surg, 2019, 69(4):1282-1292.
[20]Lazarus B, Polkinghorne KR, Gallagher M, et al; REDUCCTION Investigators.Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study[J].Am J Kidney Dis, 2024, 83(4):445-455.
[21]El Khudari H, Ozen M, Kowalczyk B, et al. Hemodialysis Catheters: Update on Types, Outcomes, Designs and Complications[J]. Semin Intervent Radiol, 2022,18,39(1):90-102.
[22]Petridis C, Nitschke M, Lehne W, et al.Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate[J].Eur J Vasc Endovasc Surg, 2017, 53(2):262-267.
[23]Jain G, Allon M, Saddekni S, Barker JF, Maya ID.Does heparin coating improve patency or reduce infection of tunneled dialysis catheters?[J].Clin J Am Soc Nephrol, 2009, 4(11):1787-1790.
[24]?zdemir M, Tayda? O, Dan??an G,et al.Comparison of the complications and long-term results of heparin-coated and non-heparin-coated symmetric-tip hemodialysis catheters[J].J Vasc Access, 2025, 26(1):139-143.
[25]Van Der Meersch H, De Bacquer D, Vandecasteele SJ, et al.Hemodialysis catheter design and catheter performance: a randomized controlled trial[J].Am J Kidney Dis, 2014, 64(6):902-908
[26]Silverstein DM.Clinical and Regulatory Considerations for Central Venous Catheters for Hemodialysis[J].Clin J Am Soc Nephrol, 2018, 13(12):1924-1932.
[27]Lew SQ, Nguyen BN, Ing TS. Unusual sites for hemodialysis vascular access construction and catheter placement: A review[J]. Int J Artif Organs, 2015, 38(6):293-303.?
[28]Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice[J]. Crit Care, 2017, 28, 21(1):225.
[29]Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group.KDOQI clinical practice quideline for vascular access: 2019 update[J].Am J Kidney Dis, 2020, 75(4）（suppl 2):S1-S164.
[30]Vegas A, Wells B, Braum P, et al.Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography[J].J Am Soc Echocardiogr, 2025, 38(2):57-91.
[31]Agarwal AK, Haddad N, Boubes K.Avoiding problems in tunneled dialysis catheter placement[J].Semin Dial, 2019, 32(6):535-540.
[32]Lazarus B, Bongetti E, Ling J, et al.Multifaceted Quality Improvement Interventions to Prevent Hemodialysis Catheter-Related Bloodstream Infections: A Systematic Review[J].Am J Kidney Dis, 2023, 82(4):429-442.
[33]K?chele M, Bettac L, Hofmann C, et al.Feasibility Analysis of Ultrasound-Guided Placement of Tunneled Hemodialysis Catheters[J].Kidney Int Rep, 2023, 8(10):2001-2007.
[34]Boulet N, Pensier J, Occean BV, et al.Central venous catheter-related infections: a systematic review,meta-analysis,trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion[J].Crit Care, 2024, 28(1):378.
[35]Ortega R, Song M, Hansen CJ, Barash P.Videos in clinical medicineUltrasound-guided internal jugular vein cannulation[J].N Engl J Med, 2010, 362(16):e57.
[36]Brass, P, Hellmich, M, Kolodziej, L, et al.Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization[J].Cochrane Database Syst Rev, 2015, 1(1):C-D006962.
[37]Brass, P, Hellmich, M, Kolodziej, L, et al.Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization[J].Cochrane Database Syst Rev, 2015, 1(1):C-D011447.
[38]Hoffman T, Du Plessis M, Prekupec MP, et al.Ultrasound-guided central venous catheterization: a review of the relevant anatomy,technique,complications,and anatomical variations[J].Clin Anat, 2017, 30(2):237-250.
[39]Miki, I, Murata, S, Nakazawa, K, et al.Anatomical relationship between the common carotid artery and the internal jugular vein during head rotation[J].Ultrasound, 2014, 22(2):99-103.
[40]王玉柱, 张丽红.血液透析长期中心静脉导管并发症诊断及防治策略[J].中国实用内科杂志, 2012, 32(9):684-686.
[41]崔锐, 郑欣, 詹申.例经颈内静脉带隧道中心静脉导管置入术分析[J].中国血液净化, 2021, 20(2):121-125.
[42]Clark E, Kappel J, MacRae J, et al; Canadian Society of Nephrology Vascular Access Work Group.Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters[J]. Can J Kidney Health Dis, 2016, 3:2054358116669128.
[43]Altuwaijri T, Nouh T, Alburakan A, et al.Long-term follow-up of endovascular repair of iatrogenic superior vena cava injury: A case report[J].Medicine (Baltimore), 2018, 97(50):e13610.
[44]Adler Y, Risti? AD, Imazio M, et al.Cardiac tamponade[J].Nat Rev Dis Primers, 2023, 9(1):36.
[45]BCPRA Hemodialysis Committee.Insertion and removal of tunneled hemodialysis catheters. 2017 [cited 2024 Apir 21]. http://www.bcrenal.ca/resource-gallery/Documents/Insertion%20and%20Removal%20of%20Tunneled%20HD%20Catheters-%20Full%20Guideline.pdf.
[46]血液透析通路相关中心静脉病变介入治疗专家组.血液透析通路相关中心静脉病变介入治疗专家建议书[J].临床肾脏病杂志, 2023, 23(4):265-283.
[47]Zhang L, Zhan S, Zhang F, et al.Recanalization of a long segment occluded superior vena cava by puncturing the remnant calcified fibrin sheath of the internal jugular vein: A case report[J].J Vasc Access, 2025, 26(3):1070-1075.
[48]Thomas B, Matsushita K, Abate KH, et al; Global Burden of Disease 2013 GFR Collaborators; CKD Prognosis Consortium; Global Burden of Disease Genitourinary Expert Group.Global Cardiovascular and Renal Outcomes of Reduced GFR[J].J Am Soc Nephrol, 2017, 28(7):2167-2179.
[49]Zhao X, Niu Q, Gan L, et al.Thrombocytopenia predicts mortality in Chinese hemodialysis patients-an analysis of the China DOPPS[J].BMC Nephrol, 2022, 23(1):11.
[50]Stamellou E, Georgopoulos C, Lakkas L, et al.tips on how to manage severe arrhythmia in haemodialysis patients[J].Clin Kidney J, 2025, 18(4):sfaf072.
[51]Saad TF, Ahmed W, Davis K, et al.Cardiovascular implantable electronic devices in hemodialysis patients: prevalence and implications for arteriovenous hemodialysis access interventions[J][J].Semin Dial, 2015, 28(1):94-100.
[52]Wang IK, Lin KH, Lin SY, et al.Permanent cardiac pacing in patients with end-stage renal disease undergoing dialysis[J][J].Nephrol Dial Transplant, 2016, 31(12):2115-2122.
[53]Kusztal M, Nowak K.Cardiac implantable electronic device and vascular access: Strategies to overcome problems[J][J].J Vasc Access, 2018, 19(6):521-527.
[54]中国医师协会心律学专业委员会, 中华医学会心电生理和起搏分会.无导线起搏器临床应用中国专家共识[J].中华心律失常学杂志, 2022, 26(3):263-271.
[55]Bhadauria D, Chellappan A, Gurjar M, et al.The "dilemma of double lifelines": central venous catheter co-existence with transvenous cardiac pacemaker[J].J Vasc Access, 2017, 18(1):e3-e5.
[56]Alfano G, Morisi N, Giovanella S, et al.Risk of infections related to endovascular catheters and cardiac implantable devices in hemodialysis patients[J].J Vasc Access, 2025, 26(2):400-416.
[57]Gibson F, Bodenham A.Misplaced central venous catheters: applied anatomy and practical management[J].British Journal of Anaesthesia J, 2013, 110(3):333-46.
[58]He H, Li B, Ma Y, et al. Catheterization in a patient with end-stage renal disease through persistent left superior vena cava: a rare case report and literature review[J]. BMC Nephrol, 2019 ,4, 20(1):202.?
[59]尹彦琪, 许戎, 程叙扬等.非切口术式拔除带隧道和涤纶套的透析导管的临床应用[J].中华肾脏病杂志, 2022, 38(7):577-582.
[60]Miller LM, Clark E, Dipchand C, et al. Hemodialysis tunneled catheter-related infections[J]. Can J Kidney Health Dis, 2016, 3:2054358116669129.
[61]Vellanki VS, Watson D, Rajan DK, et al.The stuck catheter: a hazardous twist to the meaning of permanent catheters[J].J Vasc Access, 2015, 16(4):289-293.
[62]Muthukuda C, Suriyakumara V, Samarathunga T, et al.Non-tunneled haemodialysis catheter-related blood stream infections and associated factors among first time haemodialysis patients: a prospective study from a tertiary care hospital in Sri Lanka[J].BMC Nephrol, 2024, 25(1):280.
[63]Campos E, Cuevas-Budhart MA, Cedillo-Flores R, et al.Is central venous catheter in haemodialysis still the main factor of mortality after hospitalization?[J].BMC Nephrol, 2024, 25(1):90.
[64]Oliver MJ, Mendelssohn DC, Quinn RR, et al.Catheter patency and function after catheter sheath disruption: a pilot study[J].Clin J Am Soc Nephrol, 2007, 2(6):1201-1206.
[65]Leclaire C, Lobbedez T, Henri P, et al.A New Procedure for Guidewire Exchange of Tunneled Hemodialysis Catheters in Chronic Hemodialysis Patients: A Pilot Study[J].Blood Purif, 2023, 52(1):91-100.
[66]中华医学会肾脏病学分会专家组.透析通路中国指南年版[J].中华肾脏病杂志, 2024, 40(12):990-1070.
[67]詹申, 杨涛, 张丽红, 等.球囊破坏纤维鞘纠正血液透析导管功能不良效果观察[J].中国血液净化, 2014, 13(5):405-407.
[68]Li L, Zhan S, Zhang L, et al.Tunneled dialysis catheter exchange through fibrin sheath crevice vs in situ catheter exchange for the treatment of catheter dysfunction[J].Ther Apher Dial, 2020, 24(6):695-702.
[69]Agarwal AK.Central vein stenosis[J].Am J Kidney Dis, 2013, 61(6):1001-1015.
[70]王玉柱, 张丽红.带隧道和涤纶套透析导管血栓的防治[J].肾脏病与透析肾移植杂志, 2024, 33(3):243-244.
[71]Stavroulopoulos A, Aresti V, Zounis C.Right atrial thrombi complicating haemodialysis cathetersA meta-analysis of reported cases and a proposal of a management algorithm[J].Nephrol Dial Transplant, 2012, 27(7):2936-44.
[72]Mathew GG, Kompella KK, Jayabalan R, et al.Catheter related atrial thrombus caused by Abiotrophia defectiva: A case series and review of literature[J]. J Vasc Access, 2024,25(4):1351-1354
[73]Sun J, Liu Y, Chen J, et al.Catheter replacement combined with antiplatelet therapy in hemodialysis catheter-related right atrial thrombus: a potential treatment approach[J].BMC Cardiovasc Disord, 2025, 25(1):26.
[74]Rossi L, Covella B, Libutti P, et al.How to man age catheter-related right atrial thrombosis: our conservative approach[J].J Vasc Access, 2021, 22(3):480-4.