Hemodialysis Catheter Insertion

Abstract

Non-tunneled temporary hemodialysis catheters (NHTCs) are large bore, double-lumen central venous catheters (often referred to using colloquialisms such as Quinton, Trialysis, Mahurkar, Permacath, Vascath, etc.). They are most often inserted in the ICU setting in preparation for acute hemodialysis, although they can also be used for plasmapheresis or large-volume resuscitation; they are distinguished from other CVCs by their size and lumen configuration, which are optimized to allow high-volume blood flow. There are no absolute contraindications for their use, and relative contraindications are generally technical, such as the presence of vascular abnormalities or coagulopathies. The right internal jugular site is preferred over the left, and the femoral veins are preferred over the subclavians, which are prone to venous stenosis hampering later surgical dialysis access. Insertion technique is similar to that of other CVCs, with additional dilation; however, the larger cannula size mandates a particular emphasis on stringent error-free technique. Careful catheter positioning may also be needed to ensure adequate post-placement blood flow. Real-time ultrasound-guided technique is recommended. CPT billing codes are the same as for other non-tunneled CVCs. Overall, NHTC placement is an important tool in the acute care setting and can be performed safely at the bedside by properly trained critical care clinicians.