Intervention Nephrology: Dialysis Catheter (Temporary & Tunneled Catheter)

Interventional nephrology involves procedures that use imaging guidance to diagnose and treat kidney-related conditions. Dialysis catheter placement is a common interventional nephrology procedure, especially in patients requiring temporary or tunneled catheters for hemodialysis. Let's explore both types

Temporary Dialysis Catheter

Indications

• Acute kidney injury
• Urgent need for hemodialysis

Placement

• Typically inserted into the internal jugular or femoral vein.
• Done at the bedside or in a procedure room.
• Placement is confirmed using imaging, such as ultrasound.

Features

• Short-term use (days to weeks).
• Single or double lumen design.

Complications

• Infection
• Thrombosis (blood clot formation)
• Malpositioning

Tunneled Dialysis Catheter

Indications

• Long-term need for hemodialysis.
• Frequent or chronic use.

Placement

• Inserted through a small incision (tunnel) in the skin before entering the vein.
• Typically placed in the internal jugular or subclavian vein.
• Radiological guidance (fluoroscopy) may be used.

Features

• Designed for prolonged use (months to years).
• Tunnel helps prevent infection by reducing the risk of contamination.
• Cuffed or non-cuffed design.

Complications

• Infection
• Catheter malfunction
• Thrombosis

Procedure Steps (Common to Both)

• Patient Preparation: Sterile draping and local anesthesia.
• Vascular Access: Typically, the internal jugular vein is the preferred access site.
• Guidance: Ultrasound or fluoroscopy is used to guide catheter placement and avoid complications.
• Catheter Insertion: The catheter is threaded through the vein until the tip is positioned in the large central veins near the heart.
• Securement: The catheter is secured in place, and the exit site is dressed to prevent infection.
• Confirmation: Imaging (X-ray or ultrasound) is often used to confirm proper catheter placement.

Post-Placement Care

• Regular monitoring for signs of infection, thrombosis, or other complications.
• Catheter care to prevent infections.
• Periodic catheter flushing to maintain patency.
• Follow-up imaging to assess catheter function and positioning.

Interventional nephrologists play a crucial role in the placement and management of dialysis catheters. The choice between temporary and tunneled catheters depends on the patient's needs and the expected duration of dialysis. Regular follow-up and monitoring are essential to ensure the continued effectiveness and safety of the catheter.