 Scope of the problem. A large number of hemodialysis patients in this country rely on indwelling tunneled and non-tunneled catheters as vascular access for hemodialysis even though the KDOQI guidelines discourage their use. In a study performed by ESRD network 11, to which all Michigan dialysis centers submit data 63 of patients initiated HD with a catheter as their sole form of vascular access. At 6 months after initiation of HD, 40 of these patients were still using a catheter. Other studies had shown that the prevalence of overall catheter use to be around 20 of all accesses. 