A dialysis catheter in the neck is not an ideal long-term access. International kidney guidelines recommend that, whenever circumstances allow, patients be evaluated early for a switch to their own blood vessels — an arteriovenous fistula (AVF) — rather than keeping a catheter in place for too long.
Why is a catheter not suitable for long-term use?
A central venous catheter is often used at the start of dialysis, when the blood vessels are not yet ready, or when dialysis is urgently needed. It is an important “bridging” access. International guidelines (for example KDOQI 2019) advise that most patients should be considered first for an arteriovenous access (a fistula or a graft) rather than a catheter, mainly because catheters carry a higher risk of infection. More recent guidance (for example the 2025 update from the UK Kidney Association) also stresses that the choice of access should be individualized according to vascular anatomy, age, comorbidities and patient preference, and planned early rather than applied as a one-size-fits-all rule. The long-term performance and infection risk of the three access types do differ markedly.
What the data show: long-term performance of the three access types
The UK Kidney Association’s clinical practice guideline on vascular access for haemodialysis (2023) draws on the systematic review by Almasri et al., which covers roughly 200 studies and more than 800,000 patients. KDOQI (2019) and other international guidelines likewise cite the higher infection risk of catheters as a key reason to prefer arteriovenous access:
| Access type | Primary patency at 2 years after creation | Secondary patency at 2 years | Annual incidence of Staphylococcus aureus bacteraemia (UK national registry) |
|---|---|---|---|
| Arteriovenous fistula (AVF) | ~55% | ~63% | ~1.3% per year |
| Arteriovenous graft (AVG) | ~40% | ~60% | ~4.7% per year |
| Central venous catheter | ~50% | — | ~5.7% per year |
The most important difference is infection risk. Using the annual incidence of Staphylococcus aureus bacteraemia in the UK national registry, catheters are at about 5.7% — more than four times the 1.3% seen with fistulas. This is why, even though the primary patency figure for catheters does not look poor, the guidelines still advise minimizing prolonged catheter use whenever conditions permit: infection risk is the main concern with long-term catheters.
Annual incidence of Staphylococcus aureus bacteraemia (UK national registry)
Arteriovenous fistula (AVF)
~1.3% per year
Arteriovenous graft (AVG)
~4.7% per year
Central venous catheter
~5.7% per year
Why does infection risk matter so much?
A catheter sits directly in a central vein, so the tube itself provides a route for bacteria to enter the bloodstream. A catheter-related bloodstream infection can require hospital treatment and removal and replacement of the catheter, and in severe cases may lead to systemic complications such as sepsis. A fistula, by contrast, is built from the patient’s own vessels with no foreign tube left in the body, so the infection risk is much lower.
When should evaluation for a switch begin?
If you are currently dialysing through a catheter, it is advisable to discuss a vascular assessment with your care team early. Points that will be considered include:
- Whether the arm veins are suitable for a fistula (calibre, depth and quality of the vessels)
- Whether your current health allows surgery to be scheduled
- How long the fistula will need to mature after creation before it can be used (usually several weeks to several months, depending on the individual)
Not everyone is suitable for an immediate switch. Vascular condition, heart and lung function and overall health all influence the assessment. The timing and feasibility must be decided by a physician; please do not judge for yourself or delay seeking advice.
Frequently Asked Questions
Q: Does dialysis through a catheter work poorly? Why switch?
A: A catheter can deliver the blood flow needed for dialysis. The concern is mainly the markedly higher infection risk with long-term use — not that it works poorly, but that its long-term risks must be weighed.
Q: Can everyone switch to an arteriovenous fistula?
A: Not necessarily. Vascular condition and overall health need to be assessed, and not everyone is suitable. Feasibility must be determined by a physician.
Q: Is the switching process very demanding?
A: Creating a fistula is usually an outpatient procedure. After surgery a maturation period is needed before it can be used, and during that time you may still need to dialyse through a catheter. The care team helps plan the transition.
Q: If I cannot switch for now, what should I watch for with the catheter?
A: Watch the exit site for signs of infection such as redness or discharge, follow your care team’s instructions for catheter care, and return promptly if anything seems wrong rather than waiting until symptoms are severe.
Early evaluation lowers long-term risk
A catheter is an important bridging option on the dialysis journey, but the data show that switching to your own vessels is associated with a markedly lower risk of bloodstream infection. If you are dialysing through a catheter, discuss with your care team early whether a switch is possible, rather than putting it off because “the catheter still works.” To learn more about the differences between access types, see our complete patient-education section on hemodialysis access (in Chinese), or arrange a vascular assessment clinic visit.
References: UK Kidney Association, Clinical Practice Guideline: Vascular Access for Haemodialysis (2023); Almasri et al., Journal of Vascular Surgery (2016), systematic review; KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update (Lok et al.); ESVS 2018 Clinical Practice Guidelines on Vascular Access (Schmidli et al., European Journal of Vascular and Endovascular Surgery); Aitken E, et al. UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis, BMC Nephrology 2025;26:461
