For a patient whose kidneys have failed, venous access, or access to the blood system, must be established and maintained for dialysis treatments. Placement of a chronic dialysis catheter (CDC) can provide this access. CDCs have an opening (arterial port) for blood flow out of the body and another opening (venous port) for blood return after it flows through the dialysis machine. These catheters are usually inserted in the chest or neck.
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Dialysis Catheter: General Placement
The procedure described here is a general overview of the placement of a dialysis catheter. Strict aseptic technique must be used during insertion procedure.
Chronic dialysis catheters (CDCs) are cuffed, tunneled catheters. The configuration is dual-lumen, with an arterial port for blood flow out of the body, and a venous port for blood return after flow through the dialysate. Risk of recirculation of blood is decreased by a staggered tip design.
Flow rate is an important consideration in tunneled CDC design, as faster flow rates decrease dialysis time for the patient.
Dialysis Catheter: Typical Access Sites
Generally, for tunneled CDCs, the preferred veins for central access are the right internal jugular (RIJ), right external jugular (REJ), left internal jugular (LIJ), left external jugular (LEJ)—in that order.1
The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Hemodialysis Adequacy (K/DOQI Guidelines) state that subclavian vein (SCV) catheterization should be avoided in patients with end stage renal disease (ESRD) because of the risk for central venous stenosis, with subsequent loss of the entire ipsilateral arm for vascular access.
The tunnel for the CDC is created by advancement of a tunneling device through the subcutaneous tissue on the chest wall. The tunnel may be placed medially, with the exit site at a parasternal infraclavicular location. Alternately, it may be placed laterally, with the exit site below the clavicle at the deltopectoral groove.
The cuff of the tunneled CDC acts to hold the catheter in place. In addition, it is designed to cause a fibrotic reaction, creating a physical barrier to bacteria that prevents bacterial migration and inoculation via the exit site. The cuff is positioned within the tunnel at a distance from the exit site that will facilitate removal.
1. Kaufman JA, Lee MJ. Vascular and Interventional Radiology. The Requisites. Philadelphia, PA: Mosby; 2004.
National Kidney Foundation is a registered trademark of National Kidney Foundation Corporation.
Vaxcel Plus Chronic Dialysis Catheter