Temporary Dual-Lumen Hemodialysis Catheter: Insertion Technique and Clinical Applications

The image displays a recently inserted temporary dual-lumen hemodialysis catheter positioned in the left internal jugular vein of a patient. This type of central venous access device serves as a crucial but temporary vascular access option for patients requiring urgent or short-term hemodialysis treatment. The catheter features two color-coded lumens—red for arterial (blood withdrawal) and blue for venous (blood return)—that facilitate the extracorporeal blood circuit necessary for dialysis. A transparent adhesive dressing covers the insertion site, allowing for visualization while maintaining sterility. Temporary dialysis catheters like this one are typically used when immediate dialysis is needed and there is insufficient time to establish more permanent access options such as an arteriovenous fistula or graft. While effective for short-term use, these catheters are associated with higher infection and thrombosis rates compared to permanent access methods, making them suitable primarily for acute settings or as a bridge to more definitive access placement.

Visible Components of the Hemodialysis Catheter

While there are no specific labels in the image, several key components of the temporary dual-lumen hemodialysis catheter system can be identified:

Catheter hub: This blue plastic component visible at the top of the dressing is where the dual lumens emerge from the patient’s body. The hub connects the internal portion of the catheter inserted in the vein to the external tubing used for dialysis connections. It is typically secured to the skin with sutures to prevent accidental dislodgement.

Transparent dressing: The clear adhesive film covering the insertion site and catheter hub provides a sterile barrier while allowing visual inspection of the site for signs of infection or complications. Standard protocol requires that this dressing be changed regularly, typically every 7 days or sooner if compromised.

Red arterial port: The red-colored external port connected to one lumen of the catheter is designated for blood withdrawal (the “arterial” side of the dialysis circuit). During hemodialysis, this port draws blood from the patient for filtration in the dialysis machine. The color coding prevents potentially dangerous connection errors.

Blue venous port: The blue-colored external port connected to the other lumen is designated for blood return (the “venous” side of the dialysis circuit). This port returns filtered blood to the patient’s circulation after processing through the hemodialysis machine. The spatial separation of inlet and outlet within the vessel minimizes recirculation.

Insertion site: Though partially obscured by the dressing, the catheter has been inserted into the left internal jugular vein, as indicated by its position on the left side of the patient’s neck/upper chest. This is one of the preferred sites for temporary dialysis catheter placement due to its straight path to the right atrium.

Understanding Hemodialysis Catheters

Types and Design Features

Dialysis catheters come in various configurations designed to meet specific clinical needs. These specialized central venous catheters differ significantly from standard central lines in both structure and function.

• Non-tunneled temporary catheters (shown in the image) are designed for short-term use, typically from days to a few weeks, and are inserted directly into a central vein with the exit site near the entry point.
• Tunneled cuffed catheters are designed for longer-term use (weeks to months) and feature a subcutaneous tunnel with a Dacron cuff that promotes tissue ingrowth to reduce infection risk and secure the catheter.

The dual-lumen design visible in the image is fundamental to the catheter’s function in hemodialysis. Each lumen serves a distinct purpose in creating the extracorporeal circuit needed for dialysis treatment.

• Lumen sizes typically range from 11.5-16 French, significantly larger than standard central venous catheters to accommodate the high blood flow rates (300-400 mL/min) required for effective hemodialysis.
• Modern catheters incorporate features to minimize recirculation, including staggered tip designs, side holes for improved flow, and specific tip configurations to center the catheter in the vessel lumen.

Insertion Sites and Techniques

The choice of insertion site significantly impacts catheter function and complication rates. The left internal jugular vein used in this case represents one of several possible access sites.

• The right internal jugular vein is the preferred site due to its straight path to the right atrium, lower complication rates, and typically better flow characteristics.
• The left internal jugular (shown in the image) is an acceptable alternative when the right side is unavailable due to previous procedures, anatomical variations, or other contraindications.
• Subclavian veins are generally avoided for dialysis catheters due to the risk of subclavian stenosis that could compromise future permanent access options in the ipsilateral arm.

Proper insertion technique is critical for catheter function and patient safety. Modern practice emphasizes several key safety measures during placement.

• Ultrasound guidance is now standard of care for jugular vein cannulation, reducing complications and improving first-attempt success rates.
• Real-time fluoroscopy may be used to confirm proper catheter tip position at the cavoatrial junction, optimizing flow rates and reducing mechanical complications.
• Maximum barrier precautions including cap, mask, sterile gown, gloves, and full-body drape are essential for infection prevention.

Clinical Management of Dialysis Catheters

Immediate Post-Insertion Care

Proper care immediately following catheter insertion is crucial for preventing early complications. The transparent dressing visible in the image allows for critical monitoring while maintaining sterility.

• A post-procedure chest X-ray is standard practice to confirm proper tip position and rule out complications such as pneumothorax, though this is not visible in the image.
• The catheter should be secured to prevent migration, typically using sutures and/or specialized securement devices, and covered with a sterile dressing as shown.

Initial functionality testing ensures the catheter can deliver adequate blood flow for effective dialysis treatment. This typically occurs before the patient leaves the procedure area.

• Both lumens are aspirated to confirm easy blood return and flushed with heparinized saline or a dedicated catheter locking solution.
• Flow rates are assessed to ensure they will meet the requirements for effective hemodialysis (minimum 300 mL/min).
• Any resistance to aspiration or flushing necessitates immediate investigation, as it may indicate malposition or thrombus formation.

Maintenance and Complication Prevention

Long-term catheter management focuses on preserving function while minimizing complications. Infection prevention is a particular priority for these devices.

• Catheter hub disinfection with appropriate antiseptic agents (typically alcohol or chlorhexidine) before each access is essential for preventing catheter-related bloodstream infections.
• Dressing changes follow strict protocols, typically performed weekly or when the dressing becomes damp, soiled, or loose.

Between dialysis sessions, the catheter lumens must be locked with appropriate solutions to prevent thrombosis and maintain patency.

• Traditional heparin locking (1,000-10,000 units/mL) has been increasingly supplemented or replaced by alternative lock solutions including citrate, taurolidine, and antibiotic combinations in patients with recurrent complications.
• The exact volume of locking solution must match the internal volume of each lumen to prevent systemic anticoagulation while ensuring complete filling of the catheter.

Common Complications

Despite best practices, hemodialysis catheters are associated with significant complications that often limit their long-term use. These complications fall into several categories requiring different management approaches.

• Infectious complications include exit-site infections, tunnel infections (in tunneled catheters), and catheter-related bloodstream infections, with rates significantly higher than with permanent access options.
• Mechanical complications include malposition, kinking, migration, and fibrin sheath formation, which can compromise flow rates and dialysis adequacy.

Thrombotic complications represent a major challenge in catheter management, affecting both catheter function and patient safety.

• Catheter thrombosis may be intraluminal, occur at the catheter tip, or involve fibrin sheath formation around the external catheter surface.
• Management options include thrombolytic therapy (tissue plasminogen activator), catheter exchange over a guidewire, or removal and replacement at an alternative site.

Guidelines for Temporary vs. Permanent Access

Transition Planning

Temporary catheters like the one shown in the image are designed as a bridge to more permanent access options. Clinical guidelines emphasize the importance of timely transition.

• The Kidney Disease Outcomes Quality Initiative (KDOQI) recommends that temporary non-tunneled catheters should be used for no more than 1-2 weeks when possible.
• For patients requiring longer-term dialysis, planning for permanent access should begin immediately upon catheter placement.

Early nephrology referral enables timely vascular access planning and may significantly reduce catheter dependence among dialysis patients.

• Ideally, patients with progressive chronic kidney disease should be referred for vascular access evaluation when eGFR falls below 30 mL/min/1.73m².
• Pre-emptive arteriovenous fistula creation allows time for maturation before dialysis initiation, reducing or eliminating the need for catheter placement.

Catheter Removal

When the temporary catheter is no longer needed, removal follows specific protocols to ensure patient safety. The procedure is typically straightforward but requires attention to detail.

• Prior to removal, patients are assessed for coagulation abnormalities that might increase bleeding risk.
• The procedure involves removing securing sutures, applying gentle steady traction to withdraw the catheter, and immediate pressure to the site for hemostasis.

Post-removal care focuses on preventing delayed complications such as bleeding, air embolism, or infection at the former insertion site.

• An air-occlusive dressing is typically applied for 24-48 hours following removal.
• Patients are monitored briefly after removal to ensure hemostasis and absence of respiratory symptoms that might suggest air embolism.

Conclusion

The dual-lumen temporary hemodialysis catheter shown in this clinical image represents an essential tool in the management of patients requiring urgent renal replacement therapy. While effective for immediate access, these catheters are designed for short-term use only, bridging the gap until more permanent access options can be established. Their use carries significant risks including infection, thrombosis, and mechanical complications that increase with duration of placement. Current best practices emphasize strict adherence to insertion and maintenance protocols, including maximum barrier precautions, ultrasound guidance, proper site selection, meticulous exit site care, and appropriate locking solutions between treatments. For patients with end-stage renal disease requiring long-term hemodialysis, early planning for permanent access remains the cornerstone of optimal vascular access management. Healthcare providers must balance the immediate need for dialysis access with the long-term goal of preserving vascular health and minimizing catheter-associated complications through timely transition to arteriovenous fistulas or grafts when appropriate.

1. Temporary Dual-Lumen Hemodialysis Catheter: Insertion Technique and Management Guidelines
2. Left Internal Jugular Dialysis Catheter Placement: Clinical Applications and Best Practices
3. Vascular Access for Urgent Hemodialysis: Temporary Catheter Insertion and Care
4. Non-Tunneled Hemodialysis Catheter: Identification, Maintenance, and Complication Prevention
5. Acute Dialysis Access: Understanding Temporary Dual-Lumen Catheter Placement and Management