Dialysis Catheter Insertion and Access Planning

Hemodialysis needs a safe and reliable way to reach the bloodstream, called vascular access. A dialysis catheter is a soft tube placed in a large vein that allows dialysis to begin quickly when needed. Dr. Satarupa Deb, Consultant Nephrologist at Bombay Hospital, South Mumbai, helps patients choose and plan the most suitable access, including early planning for an arteriovenous (AV) fistula.

Types of Dialysis Catheters

Dialysis catheters are usually placed in a large vein in the neck (internal jugular vein) and, less commonly, in the groin. There are two main types.

• Temporary (non-tunnelled) catheter: used for urgent or short-term dialysis, for example in acute kidney injury or when dialysis must start immediately. It is intended for short-term use because the risk of infection increases over time.
• Tunnelled (permanent or long-term) catheter: passes under the skin for a short distance before entering the vein and has a cuff that helps anchor it and reduce infection. It may be used for several weeks to months, such as while an AV fistula matures or when other access options are not possible.

What to Expect During the Procedure

Catheter insertion is usually done under local anaesthesia with ultrasound guidance to locate the vein accurately. You may be asked about blood-thinning medicines beforehand, and some blood tests may be checked. The procedure typically takes a short time, and a chest X-ray may be done afterwards to confirm the position of a neck catheter.

As with any procedure, there are some risks, including bleeding, infection, injury to nearby structures or catheter malfunction. Your doctor will explain these and answer your questions before obtaining consent.

Caring for Your Dialysis Catheter

Good catheter care helps prevent infection and keeps the catheter working well.

• Keep the dressing clean and dry; do not get the catheter wet while bathing
• Do not remove the caps or clamps, and never use the catheter for other purposes unless advised
• Allow only trained dialysis staff to handle and flush the catheter
• Seek urgent care for fever, chills, redness, pus or pain at the catheter site
• Contact your team if the catheter is pulled, cracked, bleeding or appears to have moved

Planning an AV Fistula: The Preferred Long-Term Access

For most patients on long-term hemodialysis, an AV fistula is generally the preferred access because it is associated with fewer infections and longer lasting function than catheters. A fistula is created surgically by joining an artery to a vein, usually in the forearm or upper arm, and needs several weeks to mature before use.

For this reason, patients with advanced chronic kidney disease are encouraged to discuss access planning early, ideally before dialysis becomes necessary. Preserving the veins of the non-dominant arm, by avoiding unnecessary blood draws and drips in that arm, can help. Dr. Deb assesses suitability, may advise vein mapping with ultrasound, and coordinates with the vascular surgeon for fistula creation.

When to See a Nephrologist

If you have been told your kidney function is declining, or you are currently dialysing through a catheter without a long-term access plan, a nephrology review can help. Dr. Satarupa Deb (MD Medicine, DM Nephrology, KEM Hospital, Mumbai) works with patients to reduce catheter dependence where possible and plan a safer long-term route for dialysis.

This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.