View source for Dialysis catheter placement

==Overview==
*Procedure similar to [[central line]] placement
**Precise procedural differences will depend on type of line used
*Generally, HD lines have '''larger''' diameters (12-14Fr) than TLCs and require additional dilation
*Length varies based on site of insertion
**Right Internal Jugular: 12-15 cm
**Left Internal Jugular: 15-20 cm
**Femoral Vein: 19-24 cm
*HD catheters also tend to be more '''firm''' and unforgiving than TLCs, so use caution and ultrasound!
*Location selection
**Consider coagulopathy, prior surgeries, altered anatomy, ability to tolerate lying flat etc.
**Generally, RIJ > LIJ > Femoral > subclavian
**RIJ
***Direct line to caval-atrial junction --> higher blood flow
***Less complications such as kinking, obstruction, stenosis
***Use 13.5Fr, 15cm catheter generally
**LIJ
***Tortuosity--> reduced flows
***Long catheter (19.5cm usually) required
**Femoral vein
***Easier/faster but reduces patient mobility, higher risk of infection in longer term
***Use longest possible catheter to ensure tip reaches distal IVC
**Subclavian
***Least preferred site because it is noncompressible
*Dialysis catheters typically have 2 lumens (exceptions exist such as Trialysis catheters)
**Red lumen= "arterial" = carries blood away from patient to HD machine
**Blue lumen= "venous" = carries blood from machine back to patient
*Types of dialysis catheters include:
**Shiley
**Niagara
**Trialysis
**Quinton

==Indications==
"AEIOU":
*[[Acidosis]] that is severe/refractory to medical management
*[[Electrolyte derangement]], typically severe, refractory [[hyperkalemia]]
*Ingestion; severe or otherwise untreatable overdose with [[dialyzable drugs]] (e.g. methanol, ethylene glycol, lithium, salicylates) 
*Overload of volume (e.g. hypervolemia) refractory to medical management
*[[Uremia]]

==Contraindications==
===Absolute<ref>Graham, A.S., et al. Central Venous Catheterization. N Engl J Med 2007;356:e21</ref>===
*Infection over the placement site
*Anatomic obstruction (thrombosis of target vein, other anatomic variance)
*Site-specific
**Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs

===Relative===
*Coagulopathy (see below)
*Distortion of landmarks by trauma or congenital anomalies
*Prior vessel injury or procedures
*Morbid obesity
*Uncooperative/combative patient

{{Central line with coagulopathy}}

==Equipment Needed==
*HD line kit
*Sterile gown, cap, mask, gloves
*Biopatch
*Tegaderm
*Sterile saline flush
*Sterile caps for lumen ports

==Procedure==
*Identical to [[Central venous catheterization|CVC placement]] with exception that second dilator is used prior to inserting line
*Must ensure adequate flow with 20-ml syringe due to high flow through dialysis machine

==Complications==


==See Also==


==External Links==
*http://maryland.ccproject.com/2014/03/11/vascular-access-renal-replacement-therapy/
*http://www.laminatemedical.com/hemodialysis-catheter-placement/
*https://intensiveblog.com/mastering-vascath/

==References==
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[[Category:Procedures]]
[[Category:Renal]]