Hemodialysis(HD) Catheter

HEMODIALYSIS CATHETER

A hemodialysis catheter is a small, flexible tube inserted into a large vein in the neck, chest or groin area. It serves as a temporary access point for blood to flow out of the body into a dialysis machine.

During hemodialysis catheter treatment, blood travel from the body through one tube of the catheter into the dialysis machine. HD cath filters out waste products and excess fluids from the blood. Clean blood is then returned to the body through the other tube of the catheter.

HD catheter allows the dialysis machine to clean the patient’s blood when their kidney is not working properly or failed completely. Hemodialysis with catheter is used as a short-term solution until a permanent access, like an arteriovenous fistula or graft, can be created in the arm.

Hemodialysis catheter is for people who need immediate dialysis and don’t have permanent access. As it carries a higher risk of infection and clotting than other access type, so they are not idle to use for long term.

TYPES OF HEMODIALYSIS CATHETERS:

Tunneled and Non-Tunneled Catheters

• Non-tunneled catheters are inserted directly into a vein and don’t have a longer path under the skin. This is used for short term, usually less than three weeks.
• Tunneled Catheters have a longer pathway under the skin before entering the vein. This prevents infection and allows catheters to stay for a long period, often several months.

Single-lumen and Double -lumen catheters

• Single-lumen catheters have one tube or lumen. Blood flows in and out through the same tube during dialysis.
• Double-lumen catheters have two separate tubes or lumens. One lumen is used for blood to flow out of the body, and the other lumen is used for cleaned blood to return to the body.

MATERIALS USED IN CATHETER CONSTRUCTION:

• Hemodialysis catheter is made from flexible materials like silicon or polyurethane. These materials are soft and not cause irritation inside the vein.
• Catheter tubing also coated by a special substance which help to prevent blood clotting and reduce the risk of infection.
• Some catheters have a small cuff or ridge on the part that sits under the skin. It helps body tissue to grow around the catheter, securing it in place.

INSERTION AND PLACEMENT OF HEMODIALYSIS CATHETERS:

Appropriate Insertion Sites:HD catheter are typically inserted into large veins in neck, chest or groin area. Most common insertion sites are-

• Jugular Vein (In the neck)
• Subclavian Vein (Under the collarbone)
• Femoral Vein (In the groin)

PROCEDURE FOR CATHETER INSERTION

• Insertion site is cleaned and numbed through anesthesia.
• Small incision made in skin near the vein.
• Using ultrasound or x-ray, catheter carefully inserted in the vein.
• Catheter is secured in place, and dressing is done on the insertion site.

POTENTIAL COMPLICATIONS DURING INSERTION

• Bleeding at the insertion site.
• Damage to the vein or at surroundings.
• Air bubbles entering the bloodstream.
• Infection at the insertion site.
• Nerve injury or damage.

CARE AND MAINTENANCE OF HEMODIALYSIS CATHETERS:

Dressing Changes and Catheter Site Care

• the Area around the catheter insertion needs to be kept clean.
• the dressing covering the site need to be changed regularly, after each dialysis treatment or if it gets soiled.
• While changing the dressing, the area should be clean with antiseptic solution to prevent infection.
• It's important to take care while bathing not to get wet at the catheter site.

Flushing and locking the catheter

• When not in use, catheter need to flush or locked.

Monitoring for sign of infection or clotting

• It's important to watch any sign of infection due to the catheter.
• Fever or chill can be a sign of infection. Just consult to health team.

USES OF HEMODIALYSIS CATHETERS:

Allow blood access for dialysis

One tube of catheter allows blood to flow out of the body and into the dialysis machine, where it filters and cleaned.

Return Cleaned blood to the body

The other tube of Catheter returns the cleaned blood into the patient’s body.

Provide vascular access

Hemodialysis requires access to the bloodstream, Which the catheter provides by being inserted into a large vein, usually in the neck, chest, or groin area.

Temporary vascular access

Catheters used as a short-term solution, until a more permanent vascular access can be created in the patient’s arm.

Note – Without HD cath, it would be very difficult for patients with kidney failure to receive the dialysis treatment. Catheter acts a vital link between patient’s bloodstream and the dialysis machine.

BENEFITS OF HEMODIALYSIS CATHETERS:

• Immediate vascular access: It provides immediate vascular access for patients required dialysis, used in emergency situation.
• Temporary or long-term use-Depends on the type of catheter, it can be used for short term as well as long term.
• Ease of insertion – It is a simple procedure which can be performed at the patient’s bedside or in an outpatient setting.
• Avoidance of multiple needle stick – In this patient do not need to undergo multiple stick, it reduces discomfort and complication with repeated needle insertion.
• Dual-lumen design- It allows efficient blood flow during dialysis, with separate lumens for blood inflow and outflow.
• Reversible access- If complications arise with a catheter, it can easily remove and replaced. Whereas in, surgical revision may be required for other vascular access type.
• Improved patient comfort-Compare to repeat needle insertion, A well function catheter improves patient comfort and reduce anxiety during each session of dialysis.

GUIDELINES FOR HEMODIALYSIS CATHETERS:

Before Insertion

• Proper hand hygiene follows by healthcare staff
• Catheter insertion site should be cleaned
• Use sterile drapes and gowns during insertion process.

During Insertion

• Catheter should be inserted carefully.
• Secure the catheter properly
• Apply a sterile dressing at the insertion site.

After Insertion

• Check the catheter site regularly for any redness, swelling or drainage.
• Change the dressing as instructed.
• Don’t let the catheter wet.

Catheter Care

• Don’t try to remove the catheter by yourself.
• Don’t apply cream or any ointments by yourself.
• Inform doctor immediately if catheter stopped working or for any emergency.

TRANSITIONING TO PERMANENT VASCULAR ACCESS:

• Importance of transitioning to fistula or graft – HD catheter provide temporary access, and it is not suitable for long term use. Hemodialysis permanent catheter is preferred like fistula or graft as they last longer. Hemodialysis permanent catheter fistula is created by joining artery and vein together in the arm. A graft is a synthetic tube used to join artery and vein. Both allow better blood flow for dialysis and lower the risk of infection and blood clotting.
• Timing for creating permanent access – Fitsula and craft is created a few months before dialysis. It allows time for the access to mature and develop properly. If anyone need to start the dialysis on urgency then, they will start with a catheter.  But the process of a permanent access should begin as soon as possible.

COST OF HEMODIALYSIS CATHETER:

• A basic hemodialysis catheter price used for kidney dialysis can be around Rs. 3,000 to Rs. 10,000. Exact price can vary depending on Brand, Features etc.
• Advanced or branded hemodialysis catheter price can cost around Rs. 15,000 or more.
• hemodialysis catheter kit price, which include catheter and other necessary components price is with a basic non-tunneled hemodialysis catheter kit price can cost around Rs.5000 to Rs. 10,000. Tunneled hemodialysis catheter kit price with special featured can be cost around Rs. 15,000 to Rs. 25,000.

BRANDS:

Medtronic

This is one of the biggest companies that make hemodialysis catheters. Their catheters are called Mahurkar Catheters.

Bard

It makes tunneled HD catheter, Names are Hickman and Permcath catheters.

Covidien

Brand name for hemodialysis catheter is Mahurkar Max force.

Navilyst

It makes Vaxcel chronic dialysis catheter.

Angio Dynamics

Their dialysis catheter includes Schon chronic catheter.

Medical Components

They have tray attendant and fresh start dialysis catheters.

Utah medical products

It is known for their Hemo-cath hemodialysis catheters.

FREQUENTLY ASKED QUESTIONS:

Q. What is a hemodialysis catheter?

Ans. It is a small, flexible tube inserted into a large vein, typically in the neck and chest area, to provide vascular access for hemodialysis treatment in patients having kidney failure.

Q. How is a hemodialysis catheter inserted?

Ans. It is inserted through a minor surgery, usually performed under local anesthesia. A catheter is tunneled under the skin and then into the vein.

Q. What are different types of HD cath?

Ans. Main types are tunneled cuff catheters and non-tunneled catheters.

Q. How long does HD catheter be used?

Ans. Non-tunneled catheters used for short term access up to 4-weeks, while tunneled catheters can be used for longer periods.

Q. What are the potential complications of hemodialysis catheters?

Ans. Complications include infection, clotting, catheter malfunction and damage of vein.

Q. How should a hemodialysis catheter be cared?

Ans. It can be cared by proper exit site cleaning, dressing change protocol and monitoring sign of infection or other complications.