In the case of urgent/emergent hemodialysis, where the patient does not have an AV fistula in place, what is the best site to use for hemodialysis (e.g. internal jugular)?
A large-bore dialysis catheter in the right internal jugular vein. The rationale for this site is that if the patient needs a permanent upper extremity access site, such as an AV fistula or graft, the RIJV has the most direct access to the right atrium/superior atriocaval junction and if the vein becomes stenosed or thrombosed due to the long indwelling catheter, there are other options (e.g., the entire left upper extremity).
David H Ballard Thank you very much Dr. Ballard! I really appreciate you taking the time to share your insight - it really does mean a lot to me, and your answer has been very helpful.
In severe dyspnea ( no recumbent position possible) - femoral obviously, often inserted in a patient half-sittted.
In life threatening emergency.
To save pt life.
It iw essy tu pass femoral catheter.
