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Dialysis Catheter Placement Guide: Techniques & Types
Bryant Schmitz • Updated Aug 20, 2025 • 57 hits
Dialysis is a form of renal replacement therapy used to remove waste products and excess fluid from the blood when kidney function is impaired. Access for dialysis is achieved either through the vascular system for hemodialysis or the peritoneal cavity for peritoneal dialysis. Catheter-based access is commonly used in both acute and chronic settings, with catheter type and placement tailored to the clinical scenario.
There are three main types of dialysis catheters: temporary non-tunneled catheters for short-term vascular access, tunneled cuffed catheters for longer-term hemodialysis, and peritoneal dialysis catheters for patients undergoing peritoneal dialysis. Vascular catheters are generally placed in the internal jugular or femoral veins, while tunneled catheters often exit through the chest wall. Peritoneal dialysis catheters are inserted into the peritoneal cavity, often using laparoscopic guidance to enhance placement accuracy.
Indications, Catheter Types, & Placement Routes
Dialysis catheter selection is based on clinical context, anticipated duration of use, and patient-specific anatomical or medical factors. Patients with acute kidney injury typically need urgent access through temporary non-tunneled catheters, while those initiating chronic dialysis may require tunneled catheters or peritoneal options. Anatomic constraints like central venous stenosis or prior abdominal surgery can guide route selection.
Dialysis catheters fall into three main categories, each with distinct placement protocols:
1. Temporary Non-Tunneled Catheters
Used for short-term hemodialysis access, these catheters are placed percutaneously, often at the bedside under ultrasound guidance. Typical sites include the internal jugular and femoral veins. Devices in this category include Shiley and Vascath catheters. They are most appropriate for inpatient use or in emergencies.
2. Tunneled Hemodialysis Catheters
Designed for extended use, tunneled catheters like Permcath, Mahurkar, Quinton, and Ash catheters are placed in procedural settings using both ultrasound and fluoroscopy. The catheter is tunneled subcutaneously from a chest wall exit site to the internal jugular vein, with the tip positioned at the cavoatrial junction. This configuration provides secure, lower-infection-risk access during fistula maturation or when other options are limited.
3. Peritoneal Dialysis Catheters
Used for chronic peritoneal dialysis, these catheters are inserted into the peritoneal cavity. Placement can be done via open surgery, percutaneous methods, or laparoscopically. Laparoscopic peritoneal dialysis catheter placement is preferred in many centers due to improved visualization and lower rates of early malfunction. These catheters are typically selected for patients opting for home-based therapy or with limited vascular access.
Proper alignment of catheter type with clinical indications and patient anatomy is key to minimizing complications and ensuring reliable dialysis access.
Table of Contents
(1) Temporary Non-Tunneled Dialysis Catheter Placement
(2) Tunneled Dialysis Catheter Placement
(3) Peritoneal Dialysis Catheter Placement
(4) Troubleshooting & Common Complications
(5) Post-Placement Care & Follow-Up
(6) Dialysis Catheter Placement Conclusion
Temporary Non-Tunneled Dialysis Catheter Placement
Temporary dialysis catheter placement is used in urgent or short-term dialysis scenarios, including acute kidney injury, severe electrolyte imbalances, and fluid overload. Often performed at the bedside in ICU or emergency settings, the procedure includes:
• Ultrasound-Guided Venous Access: The right internal jugular or femoral vein is cannulated using real-time ultrasound guidance.
• Guidewire and Dilator Placement: A guidewire is inserted and dilators used to prepare the tract.
• Catheter Advancement: The dialysis catheter is advanced over the guidewire into the central venous system.
• Radiographic Confirmation: Fluoroscopy or chest x-ray confirms catheter tip position.
• Securement and Dressing: The catheter is anchored and covered with a sterile dressing.
• Trialysis catheter placement provides triple-lumen functionality, useful for simultaneous dialysis and infusion needs. Due to higher infection and thrombosis risks, these catheters are intended for temporary use and should be replaced by tunneled or permanent access when feasible.
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Tunneled Dialysis Catheter Placement
Tunneled dialysis catheter placement is typically indicated for patients requiring long-term hemodialysis access. The procedure is image-guided and includes the following steps:
• Vascular Access: The internal jugular vein is accessed under ultrasound guidance.
• Wire and Tunnel Creation: A guidewire is advanced into the central circulation. A subcutaneous tunnel is created from a planned chest wall exit site to the venous access point.
• Catheter Insertion: The catheter is advanced through the tunnel and into the vein over the wire.
• Tip Positioning: Fluoroscopy confirms correct positioning of the catheter tip at the cavoatrial junction.
• Cuff Securing: The catheter cuff is embedded in the tunnel to reduce infection risk and promote tissue fixation.
• Attention to anatomic details such as previous access sites, implanted devices, and chest wall configuration is essential. Poor positioning increases the risk of thrombosis and suboptimal flow rates.
Peritoneal Dialysis Catheter Placement
Peritoneal dialysis catheter placement allows access to the peritoneal cavity for long-term dialysis. Laparoscopic placement is increasingly preferred and typically includes:
• Anesthesia and Access: Under general anesthesia, laparoscopic ports are introduced to visualize the peritoneal cavity.
• Catheter Insertion: The catheter is directed toward the pelvis through the lower abdominal wall.
• Adjunct Procedures: Omentopexy or adhesiolysis is performed if needed to reduce catheter obstruction or migration.
• Exit Site Formation: The subcutaneous exit site is planned based on patient lifestyle and habitus.
• Securement and Closure: Ports are removed and skin closed with proper catheter fixation.
• Postoperative care includes healing time before dialysis initiation and monitoring for leaks or exit site complications.
Troubleshooting & Common Complications
Complications from dialysis catheter placement can be categorized as minor or major. Minor complications include catheter kinking, partial occlusion, or low flow, often resulting from fibrin sheath formation or malpositioning. These typically present as low flow alarms or positional dysfunction and are diagnosed using radiographic imaging. Major complications involve infections such as tunnel infections or catheter-related bacteremia, as well as vascular injury, hemorrhage, or pneumothorax. In peritoneal dialysis, serious complications may include peritonitis, peritoneal leaks, and bowel perforation.
Several salvage techniques can address catheter dysfunction and avoid complete replacement. For mechanical obstructions, guidewire exchange or repositioning under fluoroscopy may restore function. Fibrin sheath stripping can be performed using angioplasty techniques or catheter exchange. Infections limited to the exit site may respond to local care and antibiotics, while deeper tunnel or cuff infections often require catheter removal. For peritoneal catheters, laparoscopic repositioning or omentopexy may resolve flow obstruction caused by omental wrapping or migration.
Post-Placement Care & Follow-Up
Post-placement management includes verifying tip position and monitoring for early complications. In dialysis catheter placement in chest locations, chest x-rays rule out pneumothorax and confirm positioning. Dressing changes and exit site care are essential to minimize infection risk, with education provided for both providers and patients.
Ongoing maintenance includes routine flushing, aseptic connection protocols, and monitoring for signs of dysfunction. Periodic imaging may be warranted for long-term catheters. In peritoneal dialysis, catheter function should be assessed before initiating therapy, with emphasis on gradual dialysate volume increases during the break-in period.
Dialysis Catheter Placement Conclusion
Dialysis catheter placement remains integral to the initiation and maintenance of renal replacement therapy. Understanding the differences between temporary, tunneled, and peritoneal catheter placement—along with appropriate indications, technical steps, and complication management—is essential for safe and effective care. Proper planning, consistent technique, and routine follow-up help reduce complications and support durable access in both acute and chronic settings.
Additional resources:
[1] Lok, C. E., & Mokrzycki, M. H. (2011). Prevention and management of catheter-related infection in hemodialysis patients. Kidney International, 79(6), 587-598. https://doi.org/10.1038/ki.2010.467
[2] Asif, A., et al. (2004). Conversion of temporary hemodialysis catheters to tunneled catheters: When and how? Kidney International, 66(6), 2417-2421. https://doi.org/10.1111/j.1523-1755.2004.66032.x
[3] Crabtree, J. H. (2006). Selected best demonstrated practices in peritoneal dialysis access. Kidney International Supplement, 70, S27–S37. https://doi.org/10.1038/sj.ki.5001980
[4] Rajan, D. K., & Clark, T. W. I. (2002). Patency of tunneled hemodialysis catheters placed by radiologists. Radiology, 225(3), 621–628. https://doi.org/10.1148/radiol.2253011551
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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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