B-14 - Dialysis Catheter Placement
  • Indications
    • Temporary or semipermanent hemodialysis access
  • Contraindications
    • Contrast allergy (requires premedication or use CO2)
    • Infection at access site
    • Inadequate vein at access site (consider alternative site)
  • Patient Evaluation
    • Ability to lie still in required position and cooperate during procedure
  • Preprocedure Orders
  • Tools
    • Micropuncture entry set
    • Uldall or Schon Hemodialysis Catheter Insertion Set
    • Rosen wire
    • Cut down tray
    • 8, 10, 12 Fr. dilators
  • Entry site
    • Right internal jugular vein, alternative left IJ.
    • Avoid subclavian veins.
  • Technique
    • Uldall Insertion: Access right internal jugular vein 1cm above clavicle with micropuncture set. Make a 2-3cm skin incision extending lateral from the venous entry site and parallel to the clavicle. If inserting a Uldall catheter, use a curved hemostat to create a subcutaneous tunnel from the lateral aspect of the incision extending 7-10cm inferiorly to a point on the chest wall. Pull the 13Fr. peel-away sheath tunneler up through the tunnel to the lateral aspect of the incision. Pass the Uldall catheter from below through the peel-away sheath and pull both through the tunnel as a unit. Remove peel-away. Insert Rosen through the micropuncture dilator. Serially dilate the venous access site to 12 Fr. and pass 13 Fr. peel-away with hemostatic valve into vein. Pass guide wire through the obturator of the Uldall (lumen #1). Remove hemostatic valve from peel-away and pass catheter through. Remove peel-away while advancing catheter. Once peel-away is removed, advance remainder of catheter into vein and position under fluoroscopy. Remove obturator from Uldall. Test catheter with saline to be certain that both lumens flush and aspirate freely. Flush and clamp both lumens. Close incision with 4-0 Prolene using vertical mattress stitch.
  • Post-procedure Note
    • Catheter may be used immediately
  • Post-procedure Orders
    1. Return to Radiology - Special Procedures one week from today for suture removal (coordinate with return to KU for dialysis)
    2. Maintain a dry gauze dressing over site until sutures are removed
    3. Bathing is permitted but site must be kept clean and dry until sutures are removed
    4. Both lumens of catheter to be flushed with heparin after each use
    5. Bruising at the entry site is normal. Please notify us if bleeding or marked swelling occurs
    6. If fever or chills occur in first 24 hr., call and ask for Interventional Radiology or the Radiologist on call.

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