A 40-year-old man with CKD stage 5 (eGFR 8 mL/min) due to diabetic nephropathy is being prepared for haemodialysis. He has no functional arteriovenous fistula yet. According to KDOQI and Indian practice guidelines, which site is PREFERRED for initial vascular access when timely fistula creation is not possible?
- A Tunneled internal jugular catheter with a cuff ✓
- B Radiocephalic arteriovenous fistula at the wrist
- C Brcchiocephalic arteriovenous fistula
- D Synthetic arteriovenous graft (PTFE)
Correct answer: A. Tunneled internal jugular catheter with a cuff
Explanation
When urgent dialysis is needed and a fistula is not ready, a tunneled cuffed central venous catheter (internal jugular preferred) is the appropriate temporary access. The 'Fistula First' initiative still applies for long-term planning, but tunneled catheters are indicated when dialysis must start before fistula maturation (6-12 weeks). Non-tunneled catheters carry higher infection risk. PTFE grafts are second-line when fistula creation is not feasible.
Reference: Brenner and Rector's The Kidney, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.