Kidney School™—a program of Medical Education Institute, Inc.

Module 8—Vascular Access: A Lifeline for Dialysis

The biggest plus of a catheter is that it can be used the same day for dialysis. So most people who find out they need dialysis right away will have a catheter. And any person on HD may need a catheter at some point if a fistula or graft needs repair. For some people, a catheter may be the only available access and dialysis lifeline.

A catheter can be inserted in an operating room, a radiology suite, or even a hospital bed. Some drugs may be given to relax you and reduce pain. Catheter placement usually takes about 15 to 30 minutes. Catheter position must be checked by an X-ray to be sure the catheter is in the right blood vessel. Ask the doctor what signs to watch out for to be sure your catheter is placed correctly.

Catheters: Helpful Tips For Women Only

If you are a woman who will need to get a catheter for dialysis, here are a few tips that can make your life easier:

  • Bring along your bra (or draw an outline of it on your chest with a surgical marker). You can't wear your bra when the catheter is being placed. But having it handy will help the doctor avoid putting the catheter in an awkward spot.
  • If the catheter will be tunneled under the skin, find out where the exit site will be. Ask the doctor not to place the catheter exit near your nipple, as this can be uncomfortable and hard to keep a dressing on.
  • The weight of large breasts can pull a catheter out. Since you are lying down when the catheter is put in, if you have large breasts, remind the doctor so he or she will be extra careful with placement and taping.

Once your catheter is in, be sure your care team teaches you how to care for it safely. You will need to know:

  • How to take a shower without getting the catheter wet
  • How to change the dressing if you need to
  • How to clamp the catheter if it starts to bleed
  • What to do if the catheter falls out or is accidentally pulled out
  • Who to call if you have a catheter problem

We'll include this list at the end of the module to help you remember what to ask.

Rarely, some people need to use catheters for long- term dialysis access. This includes people who don't have good enough blood vessels or whose hearts are not strong enough for a fistula or graft.

Long-term catheters called tunneled-cuffed catheters are held in place with stitches and a special cuff that the skin grows into. Following your care team's instructions to keep a catheter clean and free of infection will help it last longer. If the catheter becomes infected or clogged, it can be replaced.

What People Say About Dialysis with a Catheter

People who have used catheters for dialysis can tell you what it's like:

"Catheters are very temperamental—you can't move around much during treatment or alarms go off. Also, you can't shower. I was told I could shower with my permanent catheter after a certain amount of time, but it seemed that every time I showered, that's when I'd get an infection and end up in the hospital for a week. I am really much happier with my graft, even though I have to have the needle sticks."

"I blew the fistula in my arm 2 years ago, and I said the catheter won't be so bad—no needles in my arm. That isn't the case. We were only able to get a blood flow of 200 from the neck catheter, when normally it's 400—higher blood flows allow for better clearances. I couldn't wait to get that catheter out of my neck."

"I have had my tunneled-cuffed catheter in the same shoulder for almost a year and a half. I feel no pain with it now nor did I when it was put in. My arms are free during dialysis and having the catheter makes dialysis tolerable. I can turn around when I'm uncomfortable, and my machine runs at 450, which is generally unheard of with a tunneled-cuffed catheter. I count my blessings since I never had a problem with it." –Anita, 50, began dialysis in 1983

"I was hospitalized twice for catheter infections— it wasn't fun. I ran very high fevers and had to be on IV antibiotics for 10 days. Since the catheter leaves an opening into a blood vessel, you need to be very careful to avoid any source of infection. If you have to change dressings between runs, have a nurse teach you dressing change technique and give you a spare set of supplies." –Ruth, 54, began dialysis in 1996

Page 9 of 24 | Further reading