{"id":24949,"date":"2019-03-11T00:56:26","date_gmt":"2019-03-11T04:56:26","guid":{"rendered":"http:\/\/www.stepwards.com\/?page_id=24949"},"modified":"2025-03-21T23:44:20","modified_gmt":"2025-03-22T03:44:20","slug":"interventional-radiology-procedures-tunneled-hemodialysis-catheter-placement-indications-for-hemodialysis","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=24949","title":{"rendered":"Interventional Radiology Procedures: Tunneled Hemodialysis Catheter Placement (Indications For Hemodialysis)"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#FUNDAMENTAL_PREMISE_BEHIND_DIALYSIS\"><span class=\"toc_number toc_depth_1\">2<\/span> FUNDAMENTAL PREMISE BEHIND DIALYSIS<\/a><\/li><li><a href=\"#ABSOLUTE_URGENT_INDICATIONS_FOR_DIALYSIS\"><span class=\"toc_number toc_depth_1\">3<\/span> ABSOLUTE\/ URGENT INDICATIONS FOR DIALYSIS<\/a><\/li><li><a href=\"#COMMON_INDICATIONS_FOR_DIALYSIS\"><span class=\"toc_number toc_depth_1\">4<\/span> COMMON INDICATIONS FOR DIALYSIS<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>While the actual <strong><a href=\"http:\/\/www.stepwards.com\/?page_id=24941\">placement of a tunneled hemodialysis catheter<\/a><\/strong> is a technical procedure conducted by interventional radiologists, it is important to understand the basics of why such a catheter is needed in the first place. <strong>This begins with understanding the indications for hemodialysis.\u00a0<\/strong><\/p>\n<h5><span id=\"FUNDAMENTAL_PREMISE_BEHIND_DIALYSIS\"><span style=\"text-decoration: underline;\">FUNDAMENTAL PREMISE BEHIND DIALYSIS<\/span><\/span><\/h5>\n<p>Before covering too many specifics, it is important to appreciate that fundamentally the role of dialysis is compensate for a loss of renal function. This can take many different forms and can occur over various different timeframes, however the base principle remains the same. The renal system performs important physiological tasks, and when it becomes compromised, dialysis can be used to make sure that the patient&#8217;s life is not put in jeopardy from the loss of renal function.<\/p>\n<h5><span id=\"ABSOLUTE_URGENT_INDICATIONS_FOR_DIALYSIS\"><span style=\"text-decoration: underline;\">ABSOLUTE\/ URGENT INDICATIONS FOR DIALYSIS<\/span><\/span><\/h5>\n<p>Let us begin with some of the\u00a0<strong>urgent\u00a0indications for dialysis.\u00a0<\/strong>These are the ones that are not ambiguous, and when detected require that all parties involved make sure that the patient is able to receive dialysis.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>UREMIA AND ASSOCIATED SIGNS\/SYMPTOMS\/CONDITIONS<\/strong><\/span><\/p>\n<p>A large role of the kidneys is to exert waste products like uric acid. When the amount of uric acid in the serum increases patients may become symptomatic as a result. Here are some of the manifestations that can be absolute\/urgent indications for initiating dialysis.<\/p>\n<ul>\n<li><strong>Uremic pericarditis<\/strong><\/li>\n<li><strong>Uremic\u00a0<\/strong><b>pleurites<\/b><\/li>\n<li><strong>Uremic encephalopathy:\u00a0<\/strong>sometimes this may be a decline in mental status in a patient with elevated BUN which has no other explanation.<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline;\"><strong>SEVERE HYPERKALEMIA<\/strong><\/span><\/p>\n<p>An important role of the kidneys is to excrete potassium from the serum. In the absence of their function serum levels of potassium can reach dangerous levels. Generally speaking when concentrations rise above 6.5 mEq\/L \u00a0and can not be <a href=\"http:\/\/www.stepwards.com\/?page_id=15339\">controlled by medical management<\/a>\u00a0then patients may require emergency dialysis to correct electrolyte abnormalities immediately.<\/p>\n<p>Sometimes a patient&#8217;s hyperkalemia may not be too severe in the moment, however given a loss of renal function combined with rapidly rising potassium levels dialysis may need to be initiated emergently.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>SEVERE METABOLIC ACIDOSIS<\/strong><\/span><\/p>\n<p>The renal system is also responsible for maintaining (in part) the acid base balance in the body. A commonly used threshold for diagnosing severe metabolic acidosis can be a serum ph of &lt;7.1 in the setting of known renal impairment, and this can be an urgent indication to initiate dialysis.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>SEVERE OR REFRACTORY FLUID OVERLOAD<\/strong><\/span><\/p>\n<p>In the absence of proper renal function, patients will be unable to excrete fluid from the body expediently and can very easily become fluid overloaded. This is especially challenging when the medical management for certain conditions caused by loss of renal function (i.e. hyperkalemia) involves giving patients large volumes of IV fluids.<\/p>\n<p>Sometimes the patient will require dialysis simply to just remove off excess fluid that may need to be removed quickly, or fluid that has not been able to be removed with medical management.<\/p>\n<h5><span id=\"COMMON_INDICATIONS_FOR_DIALYSIS\"><span style=\"text-decoration: underline;\">COMMON INDICATIONS FOR DIALYSIS<\/span><\/span><\/h5>\n<p>The themes revolving around common indications for dialysis are related to the urgent\/absolute indications discussed above. They include:<\/p>\n<ul>\n<li><strong>Declining\u00a0nutritional status:\u00a0<\/strong>uremia can manifest by causing nausea, vomiting, and anorexia in certain populations of patients. This is actually a very common reason to initiate dialysis in patients with chronic kidney disease.<\/li>\n<li><strong>Fatigue\/malaise:\u00a0<\/strong>aslo a byproduct of uremia in certain patient populations.<\/li>\n<li><strong>Persistent\/refractory volume\u00a0overload:\u00a0<\/strong>in certain patients it may be more practical to begin treating volume status with dialysis given impaired renal function. C<\/li>\n<li><strong>Mild\u00a0cognitive impairment:\u00a0<\/strong>it can be difficult to ascertain why a patient may have cognitive impairment sometimes, and in certain contexts patients with chronic renal disease may have dialysis initiated to exclude the possibility that uremia is responsible for changes in mental status.<\/li>\n<li><strong>Refractory acidosis,\u00a0hyperkalemia, and hyperphosphatemia that is\u00a0difficult\u00a0to control with\u00a0medical\u00a0management alone:\u00a0<\/strong>at a certain point patients with chronic kidney disease may not have these conditions effectively controlled with medical management alone and can require the initiation of dialysis.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<pre>Page Updated: 03.31.2019<\/pre>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 FUNDAMENTAL PREMISE BEHIND DIALYSIS3 ABSOLUTE\/ URGENT INDICATIONS FOR DIALYSIS4 COMMON INDICATIONS FOR DIALYSIS OVERVIEW While the actual placement of a tunneled hemodialysis catheter is a technical procedure conducted by interventional radiologists, it is important to understand the basics of why such a catheter is needed in the first place. This begins with &#8230; <a title=\"Interventional Radiology Procedures: Tunneled Hemodialysis Catheter Placement (Indications For Hemodialysis)\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=24949\" aria-label=\"More on Interventional Radiology Procedures: Tunneled Hemodialysis Catheter Placement (Indications For Hemodialysis)\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":24941,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-6up","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/24949"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24949"}],"version-history":[{"count":7,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/24949\/revisions"}],"predecessor-version":[{"id":28757,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/24949\/revisions\/28757"}],"up":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/24941"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24949"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}