Complications of tunneled central venous catheter placement: a narrative review of risks, prevention, and management strategies

Background: Tunneled cuffed catheter (TCC) remains a crucial vascular access option for patients undergoing hemodialysis, particularly in those who are not candidates for arteriovenous fistulas or grafts. However, placement carries immediate and delayed complications. Objective: This narrative review aims to provide a comprehensive overview of the complications encountered during and after the placement of a TCC for hemodialysis, highlighting current evidence, risk factors, prevention strategies, and management approaches. Methods: A critical selection of relevant literature was performed through PubMed and Scopus databases, focusing on articles published in the last two decades. Particular attention was given to studies reporting on mechanical, infectious, thrombotic, and late-onset complications, as well as technical factors influencing outcomes. Results: Complications of TCCs can be classified as immediate (e.g., arterial puncture, pneumothorax, bleeding), early (e.g., catheter malposition, exit-site infections), and late (e.g., central venous stenosis, catheter-related bloodstream infections, thrombosis). Patient- and procedure-related factors increase risk. Ultrasound and fluoroscopy, strict sterility, and timely management reduce complications rates. Conclusion: TCCs are indispensable in selected patients, but understanding their complications is key to patient safety and outcomes. Optimal outcomes depend on accurate patient selection, operator expertise, and standardized post-placement care.