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Vascular access for haemodialysis

Educational resources for renal medicine

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Vascular access for haemodialysis

Since the earliest days, the ‘Achilles heel’ of haemodialysis. 

In acute renal failure, temporary access to the circulation for dialysis is achieved by inserting a wide-bore dual lumen catheter into a major vein, usually the femoral or internal jugular vein.  For patients awaiting AV fistula development or with no possibility of fistula formation, soft tunneled central catheters are used. 


Risks for all catheter devices:

  • Infection, especially by Staphylococci, which may be life-threatening.  May be difficult to eradicate without removal of catheter.  Severe secondary infections (endocarditis, discitis, osteomyelitis) may occur.
  • Thrombosis/ stenosis.  Thrombosis within the catheter can often be cleared by instillation of urokinase or tissue plasminogen activator (tPA).  Thrombosis around the catheter can alternatively be cleared by ‘stripping’ with a snare, often inserted via the femoral vein.  Occlusion of vessels is a major problem in some patients.

Catheter care programmes and recurrent cycles of audit are being increasingly used to minimise these risks.

Temporary (non-tunnelled) and femoral vein catheters are most likely to become infected. However the femoral veins are often favoured for emergency access as there is no risk of pneumothorax, insertion can be undertaken in a semi-erect patient, and it preserves central veins.
 

Further info

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Page last modified 01.12.2016, 22:49 by Administrator. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.