Name of the Procedure:

Common Name: Hemodialysis catheter placement, short-term
Medical Term: Percutaneous placement of a short-term hemodialysis/peritoneal catheter (C1752)

Summary

The procedure involves the insertion of a flexible tube, called a catheter, into a large vein in the neck, chest, or groin to provide short-term access to the bloodstream for hemodialysis. This access is crucial for filtering waste products, electrolytes, and excess fluids from the blood, especially for patients with acute kidney failure or end-stage renal disease.

Purpose

The procedure aims to provide immediate and temporary vascular access for hemodialysis. This access is used to:

• Remove toxins and waste products from the blood.
• Control blood pressure.
• Manage electrolyte imbalances.

Indications

The catheter insertion is indicated for patients with:

• Acute kidney failure.
• Chronic kidney disease requiring urgent dialysis initiation.
• Temporary dialysis needs while awaiting other long-term access, like an arteriovenous fistula or graft.

Preparation

• Patients may need to undergo blood tests to check clotting status.
• Fasting for a few hours before the procedure might be advised.
• Medication adjustments, particularly blood thinners, may be necessary.
• A physical examination and assessment of vein status are conducted.

Procedure Description

1. Preparation: The patient is positioned, and the skin is cleaned with antiseptic solution.
2. Anesthesia: Local anesthetic is applied to numb the site of insertion.
3. Insertion: A small incision is made, and a needle is inserted into the vein under ultrasound guidance.
4. Catheter Placement: A guidewire is threaded through the needle, and then a catheter is advanced over the guidewire into the vein.
5. Confirmation: The catheter placement is confirmed via x-ray.
6. Securement: The catheter is secured to the skin with sutures or adhesive materials, and a sterile dressing is applied.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The catheter placement is usually performed in a hospital setting, either in an interventional radiology suite or an operating room.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses to assist with the procedure and patient care
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common risks:

• Bleeding at the insertion site
• Infection
• Catheter misplacement Rare but serious risks:
• Pneumothorax (air in the chest cavity)
• Hemothorax (blood in the chest cavity)
• Venous thrombosis (blood clots)

Benefits

• Immediate access for hemodialysis, often lifesaving in critical conditions.
• Rapid relief from symptoms related to kidney failure.
• Short recovery time allowing for quick initiation of dialysis.

Recovery

• Patients are monitored for a few hours post-procedure for any immediate complications.
• Instructions include keeping the catheter site clean and dry, and recognizing signs of infection.
• Follow-up appointments are scheduled to assess the catheter's function and site condition.

Alternatives

• Arteriovenous Fistula: A surgically created connection between an artery and a vein; requires time to mature.
• Arteriovenous Graft: Synthetic tubing connecting an artery to a vein; suitable if a fistula is not feasible.
• Peritoneal Dialysis: Dialysis fluid is introduced into the abdominal cavity; not ideal for rapid toxin removal. Pros and Cons:
• Fistula and Graft: More durable and lower infection risk but need weeks to months before use.
• Peritoneal Dialysis: Can be done at home but less effective for acute situations.

Patient Experience

During the procedure, local anesthesia minimizes pain, though some pressure might be felt. Post-procedure discomfort and bruising at the insertion site are possible. Pain management includes oral analgesics as needed. For the duration of the catheter's use, meticulous care is necessary to prevent infection and other complications.