Interventional Radiology Procedures: Tunneled Hemodialysis Catheter Placement (Indications For A Tunneled Hemodialysis Catheter Vs. A Temporary Line)

OVERVIEW

While it is useful to know the indications for dialysis as a background, it is also pertinent to appreciate what the indications are for placing a tunneled hemodialysis line. Specifically it is useful to understand what the indications are for placing a tunneled line INSTEAD of a non-tunneled/temporary line.

The placement of a tunneled dialysis catheter is done very routinely by interventional radiologists because it has some advantages over temporary lines (image source).
LENGTH OF UTILIZATION: THE VALUE OF THE TUNNELED LINE

One of the biggest advantages a tunneled hemodialysis line can offer over a temporary/non-tunneled line is that it can be utilized for a longer time frame. Generally temporary lines are meant to be used for short term usage (5-14 days) while tunneled lines can be used for weeks until months and are recommended for patients who will require dialysis for greater then 3 weeks. 

Tunneled lines are commonly utilized for patients that will have longer term needs for dialysis and who do not currently have other means for dialyzing.As a result tunneled lines are used as a temporary bridge for patients who are awaiting for the creation/maturation/or revision of a surgically created dialysis vascular access (such as a AV fistula or graft).

*The risk of infection is lower with long term usage of tunneled lines compared to non-tunneled lines, which is why the lines can be used for a longer period of time.

PERMANENT HD CATHETERS FOR PATIENTS WHO CAN NOT RECEIVE SURGICALLY CREATED DIALYSIS ACCESS

In some cases patients may require a permanent tunneled dialysis catheter simply because they are not candidates for other forms of permanent dialysis vascular access (such as a AV fistula or graft). These are often patients who have some of the following considerations:

  • Patients with severe cardiac failure: those who can not tolerate a left to right shunt that will be caused by the creation of a AV graft/fistula
  • Patients with contraindications to surgery: this can take many forms, but often times boils down to a patient population that are not good candidates for surgery (such as patients with cardiac risk factors who are high risk for death during the operation).
  • Patients with limited lifespan (such as malignancy): if a patient has a prognosis that is relatively short, they may not be good candidates for an AV graft or fistula because these take many months to mature.

 

Page Updated: 03.31.2019