Haemodialysis Catheter Insertion

Size of catheter

In general, the bigger catheter (French gauge) the better to achieve adequate blood flow rates. The following is a guide to catheter size selection. Haemodialysis catheters are double lumen. We are transferring to a single supplier so all catheters will be Medcomp catheters. Table 1 below is for stocked catheter sizes. (See Historic Stock details below for prior non-medcomp stock/sizes if required).

Table 1. Catheter sizes

Location of the catheter

Where possible right internal jugular vein should be used. The left internal jugular vein undertakes a longer route and adequate blood flow is less consistent. Subclavian vein should be avoided as this is associated with a significant risk of subclavian stenosis which will compromise future fistula creation. Femoral vein may be utilized for uncuffed catheters.

Catheter tip position

Tip of the catheter should ideally be located at the SVC/RA junction when the right internal jugular vein is used. If the tip of the catheter is not in the distal SVC, sucking on the vein wall may occur rendering haemodialysis extremely difficult. If a femoral vein is used (uncuffed catheter), a longer catheter is required as the tip should lie in the inferior vena cava.

Catheter anticoagulation

All catheters should be flushed with heparin (1000 units/ml) with the exact volume as indicated on the hub of the catheter. The volume of heparin will be different for the arterial and venous lumens.

Vascular imaging pre catheter insertion

In patients requiring long term haemodialysis catheter placement who have a past history of central venous catheter insertion, a doppler ultrasound of the neck veins should be considered prior to the procedure. Select patients may require non-contrast MR venogram pre insertion, at the discretion of surgical team.

Post catheter insertion

1. Routine Imaging: Position of uncuffed temporary catheters should be confirmed and pneumothorax excluded by CXR for Internal Jugular (and Subclavian catheters). Line tips need to be intrathoracic and should ideally lie at the RA/SVC junction. Catheters within the RA need to be pulled back to the RA/SVC junction. Xrays are not routinely required for femoral catheters. However, if a femoral line is difficult to insert, or if blood is not freely aspirated back from both lumens immediately after insertion a lateral abdominal XR should be done to exclude line placement in an ascending lumbar vein (this is more common on the left). (Cuffed catheter line position is confirmed via fluoroscopy at time of insertion).

2. Measurement of the distance from catheter hub to exit site should be performed routinely for all cuffed catheters at time of first dialysis run and documented in patient chart/ dialysis access management plan.

3. Heparin free dialysis recommended for patients having dialysis same day as any catheter insertion.

4. Suture removal for cuffed tunnelled lines - insertion site 1 week post, exit site 2 weeks post. To be done by haemodialysis staff. Document this is done in patient chart/ dialysis access management plan.

Historic Stock Details