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Dialysis Catheter Types & Placement: Clinical Guide
Bryant Schmitz • Updated Aug 20, 2025 • 34 hits
A dialysis catheter is a vascular access device used for hemodialysis or peritoneal dialysis in patients with acute or chronic renal failure. These catheters are vital when arteriovenous fistula creation is not feasible or in urgent settings where immediate dialysis access is needed. They allow for efficient blood flow and exchange during extracorporeal therapy, making them essential for both emergent and planned treatment settings. There are two primary categories: temporary catheters for short-term use and tunneled catheters for longer-term access. Additionally, peritoneal dialysis catheters are used for intraperitoneal fluid exchange. Catheter choice and placement depend on multiple factors, including patient anatomy, dialysis duration, comorbid conditions, and infection risk.
Understanding the function and characteristics of each catheter type helps inform clinical decision-making. Emergency departments, ICUs, and nephrology units must remain equipped to evaluate catheter needs promptly. Further, ongoing advances in catheter design continue to support higher performance and reduced complication rates. Clinical teams must stay current with placement techniques, maintenance protocols, and complication management to optimize outcomes.
History & Evolution of Dialysis Catheters
Early dialysis relied heavily on non-tunneled catheters, which were frequently placed in emergent situations with minimal planning. These initial catheter designs posed high risks for infection, thrombosis, and mechanical failure. As the clinical understanding of dialysis access evolved, so did catheter design. The introduction of tunneled catheters with Dacron cuffs significantly improved infection resistance and long-term patency.
Modern catheter designs can incorporate dual lumens, curved or split tips, and radiopaque materials for enhanced visualization. Advances in material science have led to antimicrobial and antithrombogenic coatings, further reducing complication rates. The development of peritoneal dialysis catheters provided an alternative for patients requiring home-based or long-term therapy. Innovations in laparoscopic and percutaneous insertion techniques have improved comfort and access success rates. These design and procedural improvements have helped transition dialysis catheter use from a solely emergent measure to a viable option for sustained renal replacement therapy in a broader range of patients.
Table of Contents
(1) Types of Dialysis Catheters
(2) Indications, Site of Placement, & Procedural Technique
(3) Functionality & Maintenance
(4) Complications: Risks & Prevention
(5) Special Considerations & Emerging Innovations
Types of Dialysis Catheters
1. Non-Tunneled Dialysis Catheters
Non-tunneled catheters are generally used in acute settings, such as intensive care units, where short-term access is necessary. These catheters are introduced directly into central veins, including the internal jugular or femoral veins, and are typically not tunneled or cuffed. Because they are relatively simple to insert and do not require a subcutaneous tunnel, they are the preferred choice for urgent initiation of dialysis. However, they are ideal only for temporary access in critically ill patients. Their short-term design and direct venous access lead to higher risks of infection, catheter dislodgement, and thrombosis.
2. Tunneled Dialysis Catheters
Tunneled hemodialysis catheters are intended for intermediate to long-term use, particularly in patients awaiting maturation of an arteriovenous fistula or graft. These catheters are typically placed through a subcutaneous tunnel and secured with a Dacron cuff, which provides mechanical stability and reduces microbial migration along the catheter tract. The tunnel separates the skin exit site from the venous entry, decreasing the chance of bloodstream infection. Tunneled catheters are typically positioned in the internal jugular vein, with tips placed in the right atrium or superior vena cava. Their dual-lumen design supports adequate blood flow for routine dialysis sessions, and innovations in tip configuration help minimize recirculation and improve flow dynamics.
3. Peritoneal Dialysis Catheters
Peritoneal dialysis catheters are used for chronic ambulatory peritoneal dialysis and are placed into the peritoneal cavity to facilitate dialysate exchange. The most common design is the Tenckhoff catheter, which may have straight or coiled intraperitoneal segments to enhance fluid distribution and drainage. Placement can be performed using open surgical, laparoscopic, or percutaneous techniques, depending on institutional protocols and patient factors. These catheters are intended for long-term use and offer the advantage of home-based dialysis, promoting patient autonomy. Proper placement into the pelvic peritoneum and secure exit site formation are essential for effective function and infection prevention. Selection of peritoneal catheters depends on patient anatomy, peritoneal membrane characteristics, and planned dialysis regimen.
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Indications, Site of Placement, & Procedural Technique
Dialysis catheters are indicated in situations where immediate or short-notice dialysis is required or when vascular access via fistula or graft is not available. The choice of access site is guided by clinical urgency, patient anatomy, and expected duration of use. Preferred sites include the internal jugular vein due to its straight path to the right atrium, facilitating optimal blood flow and minimizing kinking. The femoral vein may be used in patients with contraindications to upper body access, but it carries a higher risk of infection. The subclavian vein is generally avoided due to the potential for central venous stenosis. Tip placement is crucial and should ideally terminate at the junction of the superior vena cava and right atrium to maximize flow and reduce recirculation.
Proper catheter placement requires pre-procedural planning, including evaluation of venous anatomy with duplex ultrasound and assessment of coagulation parameters. After sterile preparation and local anesthesia, central venous access is achieved using the Seldinger technique. For non-tunneled catheters, the device is inserted directly over a guidewire. In tunneled catheter placements, a subcutaneous tunnel is created from the exit site to the venipuncture location, and the catheter is threaded with its cuff secured subcutaneously. Fluoroscopic or radiographic confirmation is essential to ensure correct tip positioning. Peritoneal dialysis catheter placement can be performed via open surgery, laparoscopic techniques, or image-guided percutaneous methods. Proper positioning in the pelvic peritoneum reduces the risk of drainage failure and infection.
Functionality & Maintenance
Effective dialysis depends on maintaining high flow rates and minimizing complications. Catheters require routine flushing with anticoagulant solutions such as heparin or citrate to prevent intraluminal thrombus formation. Blood flow performance is assessed during dialysis sessions by evaluating pump speeds, pressures, and recirculation. Functionality may decline over time due to fibrin sheath formation or catheter malposition, both of which can be managed with pharmacologic or procedural interventions.
Maintenance protocols include regular dressing changes using sterile technique, visual inspection for signs of infection, and application of antimicrobial ointments at the exit site. Antimicrobial locking solutions are used to minimize infection risk during non-dialysis periods. When dysfunction occurs, evaluation may include pressure monitoring, flow rate analysis, or contrast studies. Interventions may range from flushing and thrombolysis to catheter exchange. A structured maintenance routine, along with early identification of issues, helps preserve catheter function and avoid unplanned access loss.
Complications: Risks & Prevention
Dialysis catheter use is associated with a range of complications that require active prevention and monitoring. Infectious risks include exit-site infections, tunnel infections, and catheter-related bloodstream infections, which can lead to sepsis and hospitalization. These are among the most frequent causes of catheter failure and patient morbidity. Strict aseptic technique during placement and maintenance, along with patient education, reduces infection rates.
Mechanical complications include catheter malposition, migration, kinking, and venous thrombosis. Imaging-guided placement and periodic function checks reduce these risks. Long-term catheter use increases the chance of central venous stenosis and subsequent challenges in future access planning. Monitoring includes regular flow assessment and periodic imaging in high-risk patients. Preventive strategies also include early planning for permanent access to minimize catheter dependence. Routine audits and adherence to catheter care protocols are key to minimizing complications and maintaining long-term access viability.
Special Considerations & Emerging Innovations
Recent advancements aim to enhance catheter performance and longevity while reducing complication rates. Innovations include bioactive catheter surfaces that resist biofilm formation, designs that optimize tip geometry to improve flow dynamics, and materials that reduce thrombus adherence. These technological improvements have made catheters more durable and less prone to failure.
Some catheters now incorporate valves or antibiotic-impregnated materials, improving safety in immunocompromised or high-risk patients. Integration with real-time imaging systems has improved placement accuracy and reduced procedural complications. Dialysis catheters continue to play a role as temporary access for patients awaiting arteriovenous fistulas or kidney transplantation. Looking ahead, evolving home dialysis technologies and wearable devices may influence future catheter designs to improve compatibility and patient autonomy. As access techniques and materials evolve, catheter-based therapy remains a flexible component of comprehensive dialysis care.
Additional resources:
[1] Durand, F., & Valla, D. (2005). Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD. Journal of Hepatology, 42(1). doi:10.1016/j.jhep.2004.11.015
[2] Tsoris, A. (2020, May 17). Use Of The Child Pugh Score In Liver Disease. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK542308/
[3] Molla, N., AlMenieir, N., Simoneau, E., Aljiffry, M., Valenti, D., Metrakos, P., Boucher, L. M., & Hassanain, M. (2014). The role of interventional radiology in the management of hepatocellular carcinoma. Current Oncology, 21(3), e480–e492. https://doi.org/10.3747/co.21.1829
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Cite This Podcast
BackTable, LLC (Producer). (2025, February 11). Ep. 516 – Dialysis Procedures: New Tools for Better Outcomes [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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