Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
Hemodialysis is a treatment used when your kidneys fail (Stage 5 Kidney Disease) and can no longer clean your blood and remove extra fluid from your body. A hemodialysis access or vascular access is a way to reach your blood for hemodialysis.
If you receive hemodialysis, your access is one of the following:
The National Kidney Foundation (NKF) recommends the AV (arteriovenous) fistula as the preferred choice for a permanent vascular access. The AV graft is the next preferred choice for a permanent access. The catheter is recommended for temporary access. There may be conditions that prevent you from having a fistula or graft and a catheter may be used.
This information is about hemodialysis catheter access. For more information on AV fistula and AV graft access also see Hemodialysis Access
The catheter used for hemodialysis is a tunneled catheter because it is placed under the skin. There are two types of tunneled catheters: cuffed or non-cuffed. Non-cuffed tunneled catheters are used for emergencies and for short periods (up to 3 weeks). Tunneled cuffed catheters, a type recommended by the NKF for temporary access, can be used for longer than 3 weeks when:
Catheters have two openings inside; one is a red (arterial) opening to draw blood from your vein and out of your body into the dialysis pathway and the other is a blue (venous) opening that allows cleaned blood to return to your body.
By taking good care of your access, it will last longer and you will prevent problems such as infection and clotting. Here are some important steps to take:
Sometimes, even when you are very careful, your access may clot or become infected.
Clots can form inside the opening of the catheter or form on the outside of the catheter and block the opening. This can cause blood to flow at a slower rate than the rate your doctor ordered. If the blood flow rate remains low for more than one dialysis treatment, the catheter should be checked and treated the same day. Early treatment may prevent the clot from totally blocking the catheter. It is important to restore the recommended blood flow rate and treat clots that are forming so that your catheter continues to work well and you get the amount of dialysis you need.
Infection can also occur even with a good blood flow rate. It is important to follow your catheter care instructions, exactly as you were taught, in order to avoid infection. You should know the following signs and symptoms of a catheter infection and report them to your doctor or dialysis team right away, so you can get the proper treatment as quickly as possible. The signs and symptoms of a catheter infection include:
Treatment depends on the type of infection but may include:
A decrease in the blood flow rate ordered by your doctor is a sign the catheter is not working as it should. If this occurs for more than one treatment in a week, the catheter should be checked. The lower blood flow rate will cause you to receive less dialysis. You will then need a longer than usual hemodialysis treatment to get the proper amount of dialysis.
Another sign that your catheter is not working well may be the pre-pump arterial pressure alarms. These sounds notify the care team that your catheter (or other vascular access) is not allowing a free draw of blood. This can be a sign that a clot is forming in the catheter blocking the flow of blood.
Treatment is the administration of a “clot busting” medication called tissue plasminogen activator (tPA). Most dialysis centers can give the medication while you are in your dialysis chair, thus preventing a hospital visit. If you are at the end of your treatment, tPA can be given just before your next dialysis appointment. Ask your doctor how you can arrange to be given this medication before your next treatment session.
If the clot is not treated when signs and symptoms of an early clot are found, the catheter can progress to be fully clotted. You may then be required to visit the hospital or vascular lab to have the catheter checked and possibly exchanged for a completely new catheter.
Your healthcare provider injects the medication directly into the catheter opening. It needs to remain inside the catheter for 30 minutes to break down the clot. After 30 minutes if enough blood flow is not restored, the doctor can repeat the process.
If you would like more information, please contact us.
©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.