Dialysis catheter placement

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 > LIF > 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
  • 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)
  • No benefit to giving FFP unless artery is punctured[2]

Equipment Needed

  • HD line kit
  • Sterile gown, cap, mask, gloves
  • Biopatch
  • Tegaderm
  • Sterile saline flush
  • Sterile caps for lumen ports

Procedure

Complications

See Also

External Links

References

  1. Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21
  2. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intens Care Med 1999; 25:5
  3. Morado M.et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia 2001; 7:551–556