Central venous catheters (CVCs) are a widely used form of dialysis access, yet for years the clinical community has avoided discussing how to improve them. That silence ended at the 2026 Charing Cross (CX) Symposium (21–23 April, London, UK), where multiple presentations placed CVCs firmly in the spotlight. Amongst them, Nicholas Inston (Birmingham, UK), CX executive board member and president-elect of the Vascular Access Society, presented findings from an international survey not only examining how dialysis catheter choices are made, but also revealing that thrombosis and fibrin sheath formation are the leading complications limiting catheter lifespan.
Inston explained: “Many patients dialyse on CVCs, which is why they remain a commonly used form of vascular access, but the community have not wanted to talk about them.” Inston attributed this reticence in part to the legacy of the Fistula First initiative, which aimed to drive down CVC use based on data linking catheters with higher mortality and morbidity. The resulting stigma, Inston argued, has been counterproductive. “CVCs have become vilified and as such no one wanted to be associated with them. We have focussed on innovations in the creation and maintenance of arteriovenous fistulas and grafts—often to no translatable clinical benefit. It’s time to start looking at catheters again and seeing how research and innovation might improve outcomes.”
Global survey exposes evidence gap
Inston used CX 2026 to present findings from an international survey of 111 vascular access clinicians across 37 countries examining how dialysis catheter choices are made. The results revealed that device performance, local availability, and ease of insertion are the primary drivers, with published clinical evidence influencing selection in only 16% of cases.
Most respondents reported that device handling characteristics provide a more practical basis for comparison than the published literature. Inston concluded that short-term device properties may be the only meaningful differentiator available to clinicians today—a symptom of a wider evidence deficit.
The survey also revealed that thrombosis and fibrin sheath formation were cited by more than half of respondents as the leading complication limiting catheter lifespan, yet confidence in existing preventive technologies was low. Inston stateed: “This survey has confirmed there is great potential to generate data and innovate here. The time has passed to ignore CVCs because they are all bad. This is a huge healthcare issue in a global market predicted to be around US$1 billion. Why there is so little data astounds me.”
New data on fibrin sheath prevention
During the Best of Abstracts session on Wednesday 22 April, Harindi Alawattegama (Newport, UK) presented a systematic literature review addressing whether fibrin sheaths can be avoided in dialysis CVCs. Her analysis found that haemocompatible-coated catheters (Palindrome-H, Medtronic) demonstrated lower rates of fibrin sheath formation compared with uncoated devices, though the volume of high-quality clinical evidence remains limited.
A further abstract in the same session described an in vitro study of a device coating (AstutePlus advanced antithrombogenic, BioInteractions) that demonstrated marked prevention of fibrin sheath deposition compared with a control uncoated catheter model.
BioInteractions shares that AstutePlus has been developed to mimic the endothelial layer by combining active and passive components to block the blood cascade, deactivate platelets and hinder the deposition and adhesion of blood components and proteins on the device surface. This reduces thrombus formation and prevents fibrin sheath development, ensuring the implant remains protected and functional for the patient’s lifetime.
A call to action
Bringing the sessions together, Inston highlighted that Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines endorse the principle of ‘the right access for the right patient at the right time’, but that inadequate evidence prevents meaningful guidance on CVC type or design selection, leaving decisions to individual clinical judgement.
Inston concluded: “The data presented here at CX 2026 confirm that there is a necessity for further research in this area—not just to develop new catheters, but to assess and use potential innovations we already have. It would seem from clinicians’ views from around the world that reducing fibrin sheath formation on dialysis catheters is a logical place to focus.”
