There are many types of catheters that are used in medical practice today.  Many people in the general public immediately think of urinary catheters when they hear the word "catheter."  However, one of the most frequently used catheters are those to gain access to the patient’s circulatory system in order to provide different types of treatments directly into the vein.  Central venous catheters (CVC) also referred to as “central lines” are used in both chronic (such as dialysis and oncology treatments) and acute care settings. When a CVC is used specifically for dialysis, it is referred to as a central venous catheter for dialysis (CVCD).

A physician, such as a vascular surgeon, interventional radiologist or interventional nephrologist, will place a CVC or CVCD into a large blood vessel returning to the heart called the vena cava.  They do this during a surgical procedure by tunneling the catheter through the neck or shoulder (clavicle) area into the target location. Once placed, the catheter has access ports outside the body (often nicknamed "pigtails") and a tube that tunnels under the skin called a “lumen” that ends deep in the vena cava where fluids can either enter into or be drawn from the vein.  Without any complications, it is realistic that a viable CVC can remain in the body providing direct access to the patient's bloodstream for as long as a year.

CVCDs are known just as much for their challenges as they are for the benefits they provide to patients. Even with the recent implementation of the National Kidney Foundation’s Fistula First Initiative, the use of CVCDs continues to rise. According to the CMS (Centers for Medicare / Medicaid Services) ESRD Clinical Performance Measures Project published in 2003, CVCDs were the “initial” vascular access method in >70% of incident hemodialysis patients from January – August 2002. In addition, approximately 300,000 CVCDs were placed in 2002 alone and the numbers the past few years continued to grow. The primary reasons for the continued growth of the use of CVCDs are that they provide relatively quick and reliable vascular access. Unfortunately, too many chronic kidney disease (CKD) patients are initially diagnosed with the disease already in an advanced stage (late Stage 4 or Stage 5 CKD) which would require a rapid vascular access method. The timing of late referrals to a nephrologist or surgeon is not conducive for the appropriate maturation of a graft or fistula. Also, many ESRD patients have very poor vascular health which would make the placement of a fistula and/or graft simply not feasible.

One of the most widely used and successful CVCDs is the Ash Split Cath® which was originally invented in 1996 by Dr. Stephen R. Ash, a co-founder of Ash Access Technology, Inc. The company continues to develop innovative catheter designs and will be looking to provide even more advanced technology in the near future that will help address the common challenges of today’s CVCDs.