Reversing HD catheter port

Q: 53 years old patient in ICU getting hemodialysis (HD). Nurse reports resistance with flow. ICU resident asked dialysis nurse to reverse the dialysis catheter's ports. By convention, red port is to draw blood from the patient, and the blue port is to return the blood from the dialysis machine back to the patient?

A) True

B) False

Answer: A

Hemodialysis catheter by default has two lumens - red and blue. The red port is by convention the draws blood from the patient and send to HD machine. The blue port returns blood from the dialysis machine back to the patient. Many times clinicians reverse the direction to improve the flow - but this may increase the risk of recirculation, reduced clearance, and possibly inadequate dialysis, as the tip configuration of catheter is not designed for this. 

Said that many catheters are now designed as self-centering with a built-in curvature designed to push the tip of the catheter away from wall of the vessel or heart chamber. This maximize the flow and may reduce recirculation when used in a reverse configuration. 

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References:

1. Silverstein DM, Trerotola SO, Clark T, et al. Clinical and Regulatory Considerations for Central Venous Catheters for Hemodialysis. Clin J Am Soc Nephrol 2018; 13:1924.

2. Vesely TM, Ravenscroft A. Hemodialysis catheter tip design: observations on fluid flow and recirculation. J Vasc Access 2016; 17:29.

3. Van Der Meersch H, De Bacquer D, Vandecasteele SJ, et al. Hemodialysis catheter design and catheter performance: a randomized controlled trial. Am J Kidney Dis 2014; 64:902.