Interventional Radiology Procedures: Tunneled Hemodialysis Catheter Placement (Fielding The Consult For A Tunneled Line Placement)

OVERVIEW

Often times other services may consult interventional radiology directly for the placement of a tunneled dialysis catheter. This is an excellent opportunity to be able to speak directly with the provider(s) who is ordering the tunneled line and make sure the right procedure is being ordered/you are able to collect pertinent information quickly.

Interventional radiologists have the opportunity to not only be proceduralists but consultants as well. It is important to be able to speak with the physicians who are ordering IR procedures and help them whenever possible (image source).
WHY DOES THIS PATIENT NEED A TUNNELED LINE (I.E. ARE OTHER FORMS OF DIALYSIS ACCESS MORE APPROPRIATE)

Perhaps the most important question that must be answered revolves around making sure that the right form of dialysis access is being ordered for the patient. It can be useful at this point to both review the indications for dialysis, the indications for a tunneled dialysis catheter, as well as the contraindications for a tunneled hemodialysis catheter however some of the most salient questions to ask the ordering physician are listed below (especially if the request is made with a short timeframe in mind).

  • How long will the patient likely require dialysis? If the patient will likely only require dialysis for 3 weeks or less a non-tunneled line is more appropriate
  • Is the patient stable? Is this a patient in the ICU? Will the patient tolerate the IR procedure? Can they lay flat for the duration of the procedure? Are they hemodynamically stable? Are they medically optimized to receive this procedure (i.e. electrolytes controlled etc).
  • Are there any concerns for sepsis/infection? Placing tunneled lines in actively infected patients is a clear contraindication given that the line will have to be removed after the infection is contained.
  • Are there any anatomical considerations/limitations for where the line can be placed? Given that a tunneled line can be placed in a few different locations, if the ordering provider has any insight on where the line should not be placed based upon their knowledge of the patient this information can be very useful to supplement the chart review that the interventionalist will also conduct for procedural planning.
  • Is the patient anti-coagulated/high risk for bleeding? Either as a result of medications (such as plavix) or from pathology (such as liver disease) is the patient anti-coagulated or at high risk of bleeding from the tunneling procedure?
  • Is the patient consent-able (and in what language)? Will the patient be able to understand the procedure and be able to give their consent for the procedure? If they are not able to give consent who can give consent for the procedure?
  • When was the last time the patient ate/drank (is the patient NPO?): this becomes relevant for timing and for the ability to give patients moderate sedation (patients need to be NPO prior to receiving sedation given the risk for aspiration).

 

Page Updated: 03.31.2019