- Institute of Renal Sciences
- Haemodialysis Catheterization
The function of the kidneys is to perform the cleansing activity in the body. The kidneys purify the blood and remove the extra fluid from the body. The kidneys fail to perform this function during end-stage renal diseases( ESRD). Haemodialysis is a treatment or procedure used when your kidneys fail to perform their designated activity. It is an artificial procedure which performs the function of the kidneys. This procedure has helped many carry on with their routine activities despite kidney failures.
Haemodialysis is the most common and safest way to treat advanced kidney failures. It is the most often used treatment for an end-stage renal disease, more commonly kidney failures. During the haemodialysis treatment, a machine pumps blood from the body through a flexible plastic tube, cleans it and then returns it to the body through a separate tube. In order to perform haemodialysis function, an access must be created. An access is a site which blood can be safely removed and returned to the body.
Side-effects of Haemodialysis ?
The common side-effects of haemodialysis are low blood pressure and muscle cramps. Sometimes if the access site is not well-maintained infections may arise. The access site must be kept very clean. There may be chances of blood clots at the access site. Patients are advised to monitor the access daily by checking for the thrill (the pulse feeling in the fistula or graft) to ensure its working fine.
What is haemodialysis catheter ?
Catheters are usually made of soft plastic material and have two vents; one is a red (arterial) opening to draw blood from the vein and out of the body into the dialysis pathway and the other is a blue (venous) opening that allows cleaned blood to return to the body. A tunneled catheter is used for haemodialysis as it is inserted under the skin. Usually, two types of tunneled catheters are used : cuffed or non-cuffed. Non-cuffed tunneled catheters are used for emergency and for a short period (up to 3 weeks). Tunneled cuffed catheters, a type recommended by the National Kidney Foundation in the USA for temporary access, can be used for longer than 3 weeks when :
- An AV fistula or graft has been placed but is not yet ready for usage.
- There are no other options for permanent access. For example, when a patient’s blood vessels are not strong enough to endure a fistula or graft.
How to insert a catheter :
Patient’s consent is a must before the procedure. The pros and cons of the procedure are well explained. The Common problems associated with catheter insertion are bleeding, the risk of infections and accidental arterial puncture. The most common problem with tunnelled catheter placements in coagulopathic patients is bleeding from the subcutaneous tunnel. Correction of underlying coagulopathies minimizes the solution.
Puncture site :
Generally, the right jugular vein is used as an access site; if the same is accumulated preference is given the other veins in the neck region. The subclavian veins may or may not be appropriate or good for central venous access. They should be avoided in haemodialysis patients as catheter insertion is associated with central venous stenosis, which can preclude shunt creation in the ipsilateral limb. If the neck or chest has no veins that can be put to use, the femoral veins can be used or attempts at recanalization or insertion via collateral veins can be attempted in such cases. This decision is based on a multitude of factors such as expected duration access, patient’s underlying condition.
The patient is prepared for the procedure and positioned for the puncture. The procedure is guided by ultrasound images and the jugular veins are accurately punctured. A vein is distinguished from an artery; in most instances as veins are easily compressible and arteries are not compressible. Local anaesthesia is administered. The probe is held in a transverse orientation or position and the centre of the probe is positioned above the targeted vein, the needle is placed on the skin at the centre of the probe and advanced on the same angle as the ultrasound probe towards the vein. The needle will pass through the slightly bent vein. After venipuncture the needle is slowly removed with very suction until dark red blood is aspirated.
Catheter placement :
Surgical shops provide a wide variety of catheters which are pre-cut and are of different sizes, catheters that are not pre-cut may be trimmed to suit the anatomy of the patient.
The catheter is inserted into the access site. The ports of the catheter are cleaned with saline water. After a catheter has been placed needle insertion is not necessary to receive haemodialysis treatment. Catheters contain an exit site, which is covered with bandages or other types of dressing. The dressings need to be changed and kept dry at all times. Many physicians recommend mupirocin ointment treatment at the exit site.
Taking care of the catheter
Catheter precautions are necessary to prevent infections :
- Keep the access site clean and dry.
- The cap of the catheter must be closed at all times; air must not enter the same.
- Wear a mask over nose and mouth any time the catheter is opened to prevent bacteria from entering the catheter and your blood stream.
- Clots may form; to prevent the same extra care must be taken.
- Fever, chills and redness around the catheter are signs of infection; they must be reported to the care- giving physician at once.
What happens when the catheter is not working well enough ?
A decrease in the blood flow rate is a sign the catheter is not working as it should be working. If this occurs for more than one procedure in a week the catheter should be checked properly. The lower blood flow rate will cause you to receive less than the requisite dialysis. You will then need a longer than usual haemodialysis treatment to get the proper requisite amount of dialysis.
Another sign that the catheter is not working well may be the pre-pump arterial pressure alarms. These sounds can notify the care team that your catheter is not allowing a free draw of blood. This can be a sign that a clot is in the catheter blocking the flow of blood and needs to be attended to. Medication is injected directly through the catheter to break down the clot.
Why KIMS ?
At KIMS, we have a dedicated state of the art dialysis unit under the supervision of expert nephrologists and trained dialysis care-givers. The patient’s are made to feel at ease during the procedure. Utmost care and precaution is taken during the haemodialysis catheterization to achieve the best results. The equipments are well-maintained and monitored on regular basis.