This page is dedicated to organizing information relevant to the placement of a tunneled hemodialysis catheter. This is a procedure that is commonly conducted in the field of interventional radiology in order to give patients a longer term form of central venous access that can be used to conduct hemodialysis. While it may seem like a relatively straightforward procedure, the placement of a tunneled dialysis line is a nuanced topic that will be covered in greater detail on this page.
WHAT IS A TUNNELED DIALYSIS CATHETER?
Simply put, a tunneled dialysis catheter is a central line that is tunneled through the subcutaneous tissues between a determined exit site on the skin and the site of venous puncture. They are used to deliver dialysis to patients who generally will require dialysis for greater then 3 weeks.
ASPECTS OF THE PROCEDURE:
Interventional radiology is a unique speciality because it intersects so many spheres of medicine. The placement of a tunneled dialysis catheter requires an appreciation for more then just the technical aspects of the procedure. An outline of relevant topics to this procedure are outlined below:
Indications For A Tunneled Hemodialysis Catheter:
- Indications for dialysis: it is important to start at the basics and make sure that it is understood why patients will require dialysis in the first place.
- Indications for a tunneled hemodialysis catheter (instead of a temporary/non-tunneled catheter): it is useful to remember that temporary/non-tunneled lines have their limitations and their are certain instances where having a tunneled hemodialysis line is superior.
Contraindications For A Tunneled Hemodialysis Catheter:
- When is it not the right time to place a tunneled line? Patients can have temporary/non-tunneled lines placed on the floor, and sometimes it is not safe to have a tunneled line placed.
Fielding The Consult For A Tunneled Hemodialysis Catheter:
- What do you do when you are consulted for a tunneled line? Other teams that order a tunneled dialysis catheter may not speak directly with the interventional radiology team for every tunneled line request, however when you have the opportunity to speak to the other provider directly it can be a good opportunity to gather more information efficiently.
- Completing a chart review: this will essentially serve as the history and physical that will need to be completed for every patient who will receive a procedure. This includes reviewing the patients history, allergies, medications, labs, imaging, etc.
- Determining what type of sedation/anesthesia the patient will require
- Holding anticoagulation/medications prior to the procedure
- Consenting the patient for the procedure
- Performing the time out right before the procedure
- How to position and prep the patient
- How to place a internal jugular vein tunneled line
- How to place a femoral vein tunneled line
- How to sign out the patient post procedure to the primary team
- How to mange a tunneled hemodialysis line on the floor
- Common issues with a tunneled line and troubleshooting tips
- When is a tunneled line no longer required?
- How to remove a tunneled hemodialysis line