Definition and Overview

Dialysis catheter placement is a minor surgical procedure performed to position a type of tube from the surface of the skin to a major vein so patients, who are suffering from conditions affecting the kidneys, can have their blood cleansed during treatment.

The kidneys, the bean-shaped organs that belong to the urinary system, are responsible for filtering wastes and other by-products of the body by converting them into urine. They are also necessary to maintain the ideal sodium level. However, in certain instances, the kidneys begin to fail.

When they start to fail, the body becomes more toxic as the wastes continue to circulate in the bloodstream. Dialysis is usually the best form of intervention.

AV fistula, graft, and catheters are the three main options for patients undergoing dialysis. Of the three, arteriovenous (AV) fistula is the most preferred. This is a surgically created vein that connects to an artery. However, it may not work for patients with really poor health, elderly, and those with thin veins. Meanwhile, an AV graft is an indirect connection, usually made of plastic that connects the vein and the artery. If AV fistula and graft are not viable options, catheters are considered.

Dialysis using catheters can be hemodialysis and peritoneal dialysis. The main difference between the two is that hemodialysis uses a dialyzer machine to filter the blood while peritoneal dialysis makes use of the belly's lining called peritoneal membrane to perform the blood exchange. Each has its pros and cons. For example, peritoneal dialysis provides more freedom of movement but has to be performed more often in a week.

The central venous catheter is the one used for hemodialysis and is inserted into a large vein. It is composed of two lumens or ports: one removes the blood from the body and moves it to the dialysis machine while the other delivers blood from the machine to the body. These types of catheters are considered as tunneled since they are buried underneath the skin.

Catheters can also be cuffed or non-cuffed, depending on the duration of the use. If it's for a long-term or chronic dialysis, a catheter with a Dacron cuff is used.

The peritoneal dialysis catheter is flexible and is made of plastic. Designs can vary depending on the manufacturer.

Who Should Undergo and Expected Results

Dialysis catheters are placed on individuals who have kidney failure, which can be acute or chronic. Acute kidney failure happens suddenly such as when the body goes through septic shock, the organs are injured, or there's heavy blood loss. Chronic kidney failure, meanwhile, occurs gradually. However, since it can be asymptomatic, the patient is often at the end-stage renal failure when it's discovered.

Dialysis is also necessary for kidney failure patients who are waiting for their transplants.

The placement of catheters takes time and preparation. There are also restrictions and plenty of recommendations on how to take care of the catheter. But as long as the patient is well trained on how to manage the catheter or it's attached by a health care professional, there should be no serious issues with them.

How Does the Procedure Work?

For the placement of the hemodialysis catheter, an ultrasound is performed to correctly identify the largest vein (usually the right jugular vein, which is found around the neck area). A micro puncture is then created to access the vein and local anesthesia is administered. A tunnel will also be made for the catheter before the tube is inserted and is moved downward the chest.

If the jugular vein is not available, femoral is considered, but it's not the most ideal since it can limit movement and can increase the risk of infection.

Meanwhile, the placement of peritoneal dialysis catheter is performed through a laparoscopic procedure. First, the patient is administered with anesthesia and small incisions are made in the abdominal area (at least 3cm from the umbilicus) to access the peritoneal membrane. As the laparoscope sends clear live images of the belly, the surgeon carefully inserts the catheter. The placement triggers an inflammatory reaction that would create fibrin clots to prevent bacteria from entering into the catheter.

Possible Risks and Complications

The risks of infection are still possible with dialysis catheters, but as the technology progresses, the rate goes down.

References:

  • National Kidney and Urologic Diseases Information Clearinghouse. Vascular Access for Hemodialysis.

  • Silva Jr. MB, Choi L, Cheng CC. Peripheral arterial occlusive disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 63.

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