The vascular access is still, after all these years, the Achilles heel in the management of haemodialysis therapy. Diabetic nephropathy and hypertension-induced atherosclerotic vascular nephropathy being the two leading causes of End Stage Renal Disease (ESRD), anno 2010 more and more patients present with severe peripheral vascular disease making the construction of an AV fistula impossible in a significant number of cases.
Central venous catheters are actually being used as a temporary vascular access in patients with Acute Kidney Injury (AKI), as a back-up access in case of a failing fistula, graft or peritoneal dialysis catheter, as a bridge access waiting for the AV –fistula or graft to reach the point of maturation and finally not in the least as a permanent vascular access in these patients with severely debilitating peripheral vascular disease and / or terminal heart failure.
From the nursing point of view, the central venous catheter is a challenge and we need to be prepared to strive for excellence in every day care. A good management of the catheter, the right caring approach, the know-how and the personal commitment are key success factors for obtaining a high level in daily practice
One important nursing contribution is the dedication to patient’s quality of life. We need to focus our efforts in this direction, use our skills and resources, and involve the patient in the caring process.
Then we can transform a necessity into quality!

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