Dialysis Catheter Placement & Care

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Dialysis Catheter Placement & Care

For a patient whose kidneys have failed, venous access, or access to the blood system, must be established and maintained for dialysis treatments. Placement of a dialysis catheter can provide this access.  Dialysis catheters are essentially large IVs with the tip of the catheter in a big vein in the chest.  The tunneled catheters, meaning they pass under the skin for several inches before entering the vein, have a small “cuff” on them that resides under the skin in the tunnel. The cuff of the tunneled dialysis catheter acts to hold the catheter in place. In addition, it is designed to cause a fibrotic reaction, creating a physical barrier to bacteria that prevents bacterial migration and spread from the tunnel to the veins in the body. The cuff is positioned within the tunnel at a distance from the exit site that will facilitate removal. 

Generally, for tunneled dialysis catheter placement, the preferred veins for central access are the right internal jugular (RIJ), or left internal jugular veins.  If these veins clot from the dialysis catheter they do no prevent future AVF placement as subclavian vein dialysis catheters do. 

If tunneled dialysis catheters are kept clean and used/flushed several days a week they can be used for dialysis for months or possibly several years.  AV fistulas are still the preferred route for long term dialysis but tunneled catheters are effective in patients that have clotted AV fistulas or cannot receive one due to poor veins in the arms.  Catheters have a higher risk of spreading infection in the body because they are exposed outside the body.  If the catheter becomes infected in must be removed and another catheter placed for dialysis.

Occasionally, dialysis catheters can grow scar over the tip in the vein, this is called a “fibrin sheath”.  Fibrin sheaths cause poor flow in the catheter during dialysis but are easily treated.  In patients with a suspected fibrin sheath the catheter is removed over a wire and a balloon expanded in the vein which tears the scar away from the catheter.  A new catheter is then put back in the same location and can be used for dialysis immediately.  This procedure only takes 15 minutes and involves minimal pain.

Transportation is Available for Tampa Patients Please Call (813) 399-1344