Nursing Management of Hemodialysis Access Using Subclavian and Femoral Catheters in an ESRD Patient with AV Fistula Contraindications: A Case Report

Background: Arteriovenous (AV) fistula is the preferred method for long-term hemodialysis access in end-stage renal disease (ESRD). However, central venous catheters, such as subclavian and femoral lines, are necessary when there are contraindications.This case study aims to describe the nursing management of vascular access in an end-stage renal disease (ESRD) patient with contraindications to arteriovenous (AV) fistula creation, highlighting the use of subclavian and femoral catheters to maintain effective hemodialysis.

Case Presentation: A 62-year-old female with a six-year history of end-stage renal disease (ESRD) secondary to diabetic nephropathy presented with malfunction of a right cuffed subclavian hemodialysis catheter. She had long-standing type 2 diabetes mellitus and hypertension and was on regular maintenance dialysis. Due to inadequate vessel size, she was not a candidate for arteriovenous fistula creation, necessitating catheter-based access. On September 5, 2025, the subclavian catheter became obstructed; urokinase was administered, temporarily restoring patency. However, recurrent thrombosis developed within days, leading to the insertion of a femoral catheter, which subsequently functioned well and allowed effective dialysis without further complications.

Conclusion: This case highlights the nursing management of an ESRD patient with contraindications to AV fistula creation who required subclavian and femoral catheters for hemodialysis. Recurrent thrombotic occlusions despite urokinase therapy emphasize the need for vigilant nursing assessment, evidence-based catheter care, and individualized vascular access planning to ensure safe and effective dialysis outcomes.