Hemodialysis catheter insertion is a vascular access procedure used for patients with acute or chronic renal failure. This treatment involves inserting a specialized catheter into a vein to establish a blood circulation pathway for hemodialysis, enabling effective removal of waste products and water. This method is commonly used in patients with acute kidney injury or during the transitional period before permanent vascular access (such as arteriovenous fistula) matures.
The procedure mainly involves two types of catheters: central venous catheters and tunneled catheters, both capable of providing immediate hemodialysis function. The core purpose is to maintain metabolic balance during renal failure, prevent the worsening of uremic symptoms, and serve as a vital life-support technique for end-stage renal disease patients.
Central venous catheters are typically inserted into the subclavian or internal jugular vein, with the tip extending near the right atrium. During dialysis, the two lumens of the catheter are used for blood withdrawal and return, forming an extracorporeal circuit. Tunneled catheters (such as Hickman or Groshong types) are designed with subcutaneous tunneling to reduce infection risk and allow for long-term use.
The catheter materials are mostly high-elasticity silicone or polyurethane, with surface coating technologies to reduce thrombosis. The blood flow rate needs to reach 300-350 ml/min to meet dialysis requirements. The insertion site and catheter length are precisely adjusted based on the patient’s anatomy.
Suitable for patients with poor bilateral upper limb vein conditions or those unable to establish autologous fistula. When patients have heart failure requiring rapid fluid regulation, catheter insertion can quickly establish an efficient blood access route.
The procedure is usually performed under local anesthesia, with catheter insertion via puncture of the internal jugular or subclavian vein. The depth of catheter placement must be accurately measured, with the tip located at the junction of the superior vena cava and right atrium. The operation takes approximately 30-60 minutes, and post-insertion X-ray confirmation of the position is required immediately.
During catheter use, strict adherence to care guidelines is essential: daily disinfection of the access points, periodic flushing to prevent thrombosis, and single-session dialysis should not exceed 12 hours. For long-term indwelling catheters, blood flow velocity should be evaluated every 4-6 weeks to ensure patency.
Tunneled catheters have lower infection rates compared to non-tunneled designs and can withstand higher blood flow rates. Their flexible materials reduce vascular injury risk, making them suitable for long-term use (up to several months or more than a year).
Serious complications include: thrombophlebitis (incidence approximately 15-20%), catheter-related sepsis (annual incidence 10-15%). Puncture site redness, swelling, or pain may occur 3-5 days post-insertion, requiring close monitoring for signs of infection.
Long-term indwelling may lead to central venous stenosis (annual incidence 2-5%), with rare emergencies such as pneumothorax or cardiac tamponade. Tip displacement or thrombosis can cause inadequate dialysis, requiring immediate imaging assessment.
Contraindications include existing infection at the insertion site, coagulation abnormalities (such as INR >1.5), and severe clotting factor deficiencies. Diabetic patients should strengthen blood sugar control to reduce infection risk, and hemophilia patients must use prophylactic hemostatic agents.
After catheter placement, avoid heavy lifting on the punctured limb, protect the access site with waterproof dressings during bathing, and seek medical attention immediately if fever, purulent discharge, or sudden flow reduction occurs.
Anticoagulant dosage adjustments are necessary: heparin lock solutions and systemic anticoagulation may increase bleeding risk. When combined with antiplatelet drugs (such as aspirin), enhanced monitoring for subcutaneous bleeding is required.
For patients sharing central venous catheters, avoid placing multiple catheters in the same vascular area to prevent stenosis. During radiological examinations, attention should be paid to the impact of catheter materials on imaging, and temporary removal may be necessary.
Clinical studies show that the 1-year retention rate of tunneled catheters is approximately 70-80%, and in patients with acute kidney failure, serum creatinine clearance can improve by 40-60% post-insertion. Catheter-related infection rates are directly related to care quality, with specialized centers reporting lower infection rates than general wards.
Compared to autologous arteriovenous fistulas, catheters have higher initial dialysis efficiency but a 3-5 times higher long-term infection risk. Randomized controlled trials confirm that prophylactic use of antimicrobial dressings can reduce infection rates by up to 30%.
Selection of alternatives should consider patient vascular conditions and expected duration of use. The success rate of fistula creation in Taiwan is approximately 65-75%, with preoperative Doppler ultrasound assessment of vessel diameter and flow velocity recommended.
What preparations are needed before inserting a hemodialysis catheter?
Preoperative assessments include blood coagulation tests and infection screening, with evaluation of vascular conditions by the physician. Patients should inform their doctor of allergies and current medications (such as anticoagulants), and avoid strenuous activity on the punctured arm. Fasting for 4-6 hours before surgery and accompaniment by family members for post-operative observation are recommended.
How to prevent catheter-related infections after placement?
Daily disinfection of the puncture site with dedicated antiseptic solutions, keeping dressings dry and free of seepage. Avoid heavy lifting or blood pressure measurement on the punctured arm. Use waterproof dressings during bathing, and seek medical attention if redness, swelling, fever, or discharge occurs. Regular blood culture monitoring can help early detection of potential infections.
Can I engage in normal activities after catheter placement? Are there movements I should avoid?
Light activities such as walking or household chores are permissible, but avoid raising the arm on the catheter side above the head, lifting objects over 1 kg, or contact with dirty water environments. When sleeping, use pillows to support the catheter side to prevent displacement. Strenuous or contact sports should only be undertaken with medical approval.
What should I do if I experience pain or swelling at the insertion site?
Applying ice to the puncture site can alleviate mild discomfort, but severe pain or persistent swelling may indicate thrombosis or infection, requiring immediate medical attention. Wearing loose clothing can reduce friction, and avoid bending at the puncture site. Doctors may prescribe topical anesthetic gels or short-term analgesics, but avoid self-medicating with anti-inflammatory drugs.
What is the lifespan of a hemodialysis catheter and how often should it be replaced?
Temporary catheters (such as femoral vein catheters) are recommended for use no longer than 4 weeks. Tunneled catheters (such as Hickman) can last from several months to several years, but require dressing changes every 4 weeks and weekly position checks. Long-term use necessitates regular X-ray assessments to confirm the tip position. If signs of inadequate flow or occlusion occur, evaluation by a specialist nurse for cleaning or replacement is necessary.
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