Dialysis catheter placement: Difference between revisions
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*Location selection | *Location selection | ||
**Consider coagulopathy, prior surgeries, altered anatomy, ability to tolerate lying flat etc. | **Consider coagulopathy, prior surgeries, altered anatomy, ability to tolerate lying flat etc. | ||
**Generally, RIJ > | **Generally, RIJ > LIJ > Femoral > subclavian | ||
**RIJ | **RIJ | ||
***Direct line to caval-atrial junction --> higher blood flow | ***Direct line to caval-atrial junction --> higher blood flow | ||
| Line 21: | Line 21: | ||
***Easier/faster but reduces patient mobility, higher risk of infection in longer term | ***Easier/faster but reduces patient mobility, higher risk of infection in longer term | ||
***Use longest possible catheter to ensure tip reaches distal IVC | ***Use longest possible catheter to ensure tip reaches distal IVC | ||
**Subclavian | |||
***Least preferred site because it is noncompressible | |||
*Dialysis catheters typically have 2 lumens (exceptions exist such as Trialysis catheters) | *Dialysis catheters typically have 2 lumens (exceptions exist such as Trialysis catheters) | ||
**Red lumen= "arterial" = carries blood away from patient to HD machine | **Red lumen= "arterial" = carries blood away from patient to HD machine | ||
| Line 29: | Line 31: | ||
**Trialysis | **Trialysis | ||
**Quinton | **Quinton | ||
==Indications== | ==Indications== | ||
| Line 64: | Line 65: | ||
==Procedure== | ==Procedure== | ||
*Identical to [[Central venous catheterization|CVC placement]] with exception that second dilator is used prior to inserting line | |||
*Must ensure adequate flow with 20-ml syringe due to high flow through dialysis machine | |||
==Complications== | ==Complications== | ||
Latest revision as of 05:08, 22 November 2020
Overview
- Procedure similar to central line placement
- Precise procedural differences will depend on type of line used
- Generally, HD lines have larger diameters (12-14Fr) than TLCs and require additional dilation
- Length varies based on site of insertion
- Right Internal Jugular: 12-15 cm
- Left Internal Jugular: 15-20 cm
- Femoral Vein: 19-24 cm
- HD catheters also tend to be more firm and unforgiving than TLCs, so use caution and ultrasound!
- Location selection
- Consider coagulopathy, prior surgeries, altered anatomy, ability to tolerate lying flat etc.
- Generally, RIJ > LIJ > Femoral > subclavian
- RIJ
- Direct line to caval-atrial junction --> higher blood flow
- Less complications such as kinking, obstruction, stenosis
- Use 13.5Fr, 15cm catheter generally
- LIJ
- Tortuosity--> reduced flows
- Long catheter (19.5cm usually) required
- Femoral vein
- Easier/faster but reduces patient mobility, higher risk of infection in longer term
- Use longest possible catheter to ensure tip reaches distal IVC
- Subclavian
- Least preferred site because it is noncompressible
- Dialysis catheters typically have 2 lumens (exceptions exist such as Trialysis catheters)
- Red lumen= "arterial" = carries blood away from patient to HD machine
- Blue lumen= "venous" = carries blood from machine back to patient
- Types of dialysis catheters include:
- Shiley
- Niagara
- Trialysis
- Quinton
Indications
"AEIOU":
- Acidosis that is severe/refractory to medical management
- Electrolyte derangement, typically severe, refractory hyperkalemia
- Ingestion; severe or otherwise untreatable overdose with dialyzable drugs (e.g. methanol, ethylene glycol, lithium, salicylates)
- Overload of volume (e.g. hypervolemia) refractory to medical management
- Uremia
Contraindications
Absolute[1]
- Infection over the placement site
- Anatomic obstruction (thrombosis of target vein, other anatomic variance)
- Site-specific
- Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs
Relative
- Coagulopathy (see below)
- Distortion of landmarks by trauma or congenital anomalies
- Prior vessel injury or procedures
- Morbid obesity
- Uncooperative/combative patient
Central line if coagulopathic
- Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible, though IJ preferred over subclavian)
- No benefit to giving FFP unless artery is punctured[2]
- However, consider giving FFP if patient has hemophilia[3]
Equipment Needed
- HD line kit
- Sterile gown, cap, mask, gloves
- Biopatch
- Tegaderm
- Sterile saline flush
- Sterile caps for lumen ports
Procedure
- Identical to CVC placement with exception that second dilator is used prior to inserting line
- Must ensure adequate flow with 20-ml syringe due to high flow through dialysis machine
Complications
See Also
External Links
- http://maryland.ccproject.com/2014/03/11/vascular-access-renal-replacement-therapy/
- http://www.laminatemedical.com/hemodialysis-catheter-placement/
- https://intensiveblog.com/mastering-vascath/
References
- ↑ Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
- ↑ Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
- ↑ Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556