Permanent and Temporary Catheter Insertion For Dialysis
Catheter insertion is a key procedure in hemodialysis, allowing direct access to a patient’s bloodstream for filtering waste, toxins, and excess fluids. Dialysis catheters are categorized into temporary and permanent types, depending on the duration of their use and the patient’s clinical needs.
Dialysis catheters serve as vital access points for patients undergoing hemodialysis, enabling the removal and return of blood for filtering. Depending on the urgency and duration of dialysis treatment, catheters are classified as temporary or permanent. The type chosen depends on the patient’s condition, medical history, and the feasibility of other vascular access methods such as arteriovenous (AV) fistulas or grafts.
Temporary Catheter for Dialysis
Definition:
Temporary catheters are designed for short-term use, typically in emergency situations or when immediate dialysis access is required.
Common Features:
- Placement: Usually inserted into large veins like the internal jugular vein, subclavian vein, or femoral vein.
- Duration: Used for a few days to weeks.
- Material: Soft, flexible materials that allow easy insertion and removal.
- Design: Double-lumen structure (one lumen for blood removal, the other for blood return).
Indications:
- Acute kidney injury requiring urgent dialysis.
- Chronic kidney disease patients awaiting permanent access placement.
- Catheter replacement during infection or malfunction of a permanent catheter.
Procedure:
- Preparation: Local anesthesia is applied, and the area is cleaned to maintain sterility.
- Insertion: A catheter is guided into the vein using ultrasound or fluoroscopic guidance.
- Securing: The catheter is sutured in place, and sterile dressings are applied.
Advantages:
- Quick and easy to place.
- Suitable for emergency dialysis needs.
Permanent Catheter for Dialysis
Definition:
Permanent catheters, also called tunneled dialysis catheters, are used for long-term dialysis access in patients who cannot undergo arteriovenous (AV) fistula or graft placement.
Common Features:
- Placement: Inserted into the internal jugular vein, with a portion tunneled under the skin to reduce infection risk.
- Duration: Used for weeks to months, sometimes longer.
- Material: Durable, biocompatible materials designed for prolonged use.
- Design: Double-lumen structure for efficient blood flow during dialysis.
Indications:
- Chronic kidney disease patients with contraindications for AV fistulas or grafts.
- Temporary access while waiting for AV fistula maturation.
- Long-term access for patients not suitable for surgical access creation.
Procedure:
- Preparation: Local or general anesthesia is administered, and the area is sterilized.
- Tunneling: A small incision is made to create a subcutaneous tunnel for the catheter.
- Insertion: The catheter is guided into the vein using ultrasound and fluoroscopy for precise placement.
- Securing: The catheter is anchored and covered with sterile dressing.
Advantages:
- Lower infection risk compared to temporary catheters.
- Suitable for extended periods when AV access is not feasible.
Comparison of Temporary and Permanent Catheters
| Feature | Temporary Catheter | Permanent Catheter |
|---|---|---|
| Duration | Days to weeks | Weeks to months |
| Placement | Simple venous insertion | Tunneled under the skin into a vein |
| Infection Risk | High | Moderate |
| Indications | Emergency or short-term use | Long-term use when AV access is not possible |
| Maintenance | Minimal | Requires regular care and flushing |
Care and Maintenance
- Sterile Technique: Dressing changes and flushing should always follow strict aseptic protocols.
- Regular Flushing: Prevents clot formation inside the catheter.
- Monitoring: Check for signs of infection (redness, swelling, fever) or malfunction.
- Patient Education: Patients should be instructed on proper hygiene and when to seek medical attention.