Background Information:

What are the other Names for the Procedure?

• Mahurkar Catheter Placement
• Quinton Catheter Placement
• Temporary Dialysis Access

What is Temporary Dialysis Catheter Placement radiology procedure? (General Explanation)

• Dialysis is an artificial means to perform the function of the kidneys, through a series of filters and semipermeable membranes
• Hemodialysis is the process of filtering blood and requires vascular access (access through a blood vessel)
• A Temporary Dialysis Catheter Placement radiology procedure is specially designed plastic tubing inserted in a large vein used to perform hemodialysis

What part of the Body does the Procedure involve?

The Temporary Dialysis Catheter Placement radiology procedure involves the insertion of a catheter into a large vein, commonly near the neck.

Why is the Temporary Dialysis Catheter Placement radiology procedure Performed?

Common reasons for performing a Temporary Dialysis Catheter Placement radiology procedure include:

• Acute kidney failure
• Chronic kidney disease requiring dialysis

What are the Alternative Choices for the Procedure?

There are permanent alternatives for dialysis access, such as an arteriovenous fistula or peritoneal dialysis; however, neither of these options can provide immediate an access, nor replace a temporary catheter

What is the Equipment used? (Description of Equipment)

The following equipment is used for the Temporary Dialysis Catheter Placement procedure:

• A long firm, but flexible plastic tubing, often with multiple nozzles that connect to the dialysis machine
• The catheter commonly has 2-3 lumens to allow blood to flow in multiple directions
• The equipment used to inset the catheter includes:
  • X-ray or real-time X-ray fluoroscopy unit
  • Ultrasound unit
  • Small needle
  • Guidewire

What are the Recent Advances in the Procedure?

• There have been many advances in catheter design, to prevent infections and clots from developing within the plastic tubing
• The use of ultrasound-guided insertions has also drastically reduced the complications of local damage including lung collapse

What is the Cost of performing the Temporary Dialysis Catheter Placement radiology procedure?

The cost of a Temporary Dialysis Catheter Placement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the need of a Temporary Dialysis Catheter Placement procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Frankel A. Temporary access and central venous catheters. European Journal of Vascular and Endovascular Surgery. 2006;31(4):417-422. https://www.sciencedirect.com/science/article/pii/S1078588405006003. Accessed Feb 8, 2017. doi: 10.1016/j.ejvs.2005.10.003.

Prior to Temporary Dialysis Catheter Placement radiology procedure:

How does the Temporary Dialysis Catheter Placement radiology procedure work?

• Hemodialysis works by a system of semipermeable membranes and filters, to filter blood through a machine placed outside the body
• The temporary dialysis catheter allows blood to flow to the filters, as well as back into the body
• The catheter is specially designed to handle a large amount of flow required for hemodialysis

How is the Temporary Dialysis Catheter Placement radiology procedure Performed?

The Temporary Dialysis Catheter Placement radiology procedure is performed in the following manner:

• The individual is positioned on the examination table
• The site of insertion is cleaned and draped to prevent an infection
• A small amount of local numbing medication is injected in the site
• Once the area is numb, the vein is located, either through anatomical landmarks, or under ultrasound guidance
• The vein is accessed with a small needle
• A guidewire is then threaded through the needle and the needle is removed
• A series of plastic dilators are used over the guidewire, to enlarge the opening in the skin and surrounding tissue
• The temporary dialysis catheter is then inserted over the guidewire. Once the catheter is in place, the guidewire is removed
• A chest X-ray is taken to ensure the location of the catheter i.e., it sits near the level of the heart
• Once the positioning of the catheter is confirmed, it is stitched in place

Where is the Procedure Performed?

The Temporary Dialysis Catheter Placement radiology procedure is commonly performed as an inpatient procedure at a hospital.

Who Performs the Procedure?

Depending on the institution, the healthcare specialist who performs the Temporary Dialysis Catheter Placement radiology procedure may be an interventional radiologist or a vascular surgeon.

How long will the Procedure take?

The duration of the procedure may vary depending upon many factors; but, in general, it should take less than 2 hours.

Who interprets the Result?

The position of the catheter will be confirmed with a chest X-ray by the physician, who performed the Temporary Dialysis Catheter Placement radiology procedure, and confirmed by a radiologist.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Temporary Dialysis Catheter Placement radiology procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• Women should notify the physician if they are pregnant or breastfeeding their child; as many such procedures, may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the test

What is the Consent Process before the Procedure?

A physician will request your consent for the Temporary Dialysis Catheter Placement procedure using an Informed Consent Form.

Consent for the Temporary Dialysis Catheter Placement procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Temporary Dialysis Catheter Placement procedure:

• A temporary dialysis catheter can provide immediate access for a dialysis
• The catheter may also be used for ‘blood draws’

Following are the risks of the Temporary Dialysis Catheter Placement procedure:

• There is a small chance of damaging the surrounding structure such as the arteries or nerves
• If the catheter is inserted deep, there is a potential to cause irregular heartbeats
• The line may develop a clot, which requires to be cleared
• In rare cases, a piece of the catheter may break-off and travel into the bloodstream
• The catheter/line may serve as a site of infection
• Rarely, on insertion, the needle can pass into the chest cavity and cause a lung collapse
• Extremely rarely, air may enter the venous system causing an air embolism. This can be minimized with new/advanced techniques

What are the Limitations of the Temporary Dialysis Catheter Placement radiology procedure?

The Temporary Dialysis Catheter Placement radiology procedure is only suited for a short-term. It does not provide long-term access, such as possible through a fistula or peritoneal dialysis procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Temporary Dialysis Catheter Placement procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• How long will I have this catheter?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Temporary Dialysis Catheter Placement radiology procedure:

What is expected during the Temporary Dialysis Catheter Placement radiology procedure?

The following may be expected during the Temporary Dialysis Catheter Placement procedure:

• A slight poke and burning sensation may be felt during administration of the local numbing medicine
• Once the area is numb no pain is felt; but, a pressure sensation with the dilators, or during insertion of the catheter, may be experienced
• Once the catheter is in place, there may be a sensation of fullness in the neck region

What kind of Anesthesia is given, during the Procedure?

A local anesthetic is normally given to temporarily numb the area.

How much Blood will you lose, during the Procedure?

Since the Temporary Dialysis Catheter Placement radiology procedure is a minimally-invasive one, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Temporary Dialysis Catheter Placement radiology procedure?

The possible risks and complications during the radiology procedure include:

• Rarely, the catheter may become displaced and become mal-positioned
• Very rarely, a small fragment of the catheter may break-off and travel into the bloodstream
• The catheter may serve as a site for infection requiring it to be removed
• Rarely, and accidentally, the needle may be passed into the chest cavity causing a lung collapse
• Extremely rarely, there is a risk of introducing air into the bloodstream that can be potentially fatal. However, newer and more advanced techniques have drastically reduced this risk

What Post-Operative Care is needed at the Healthcare Facility after the Temporary Dialysis Catheter Placement radiology procedure?

• A chest X-ray is performed to ensure proper positioning of the catheter
• The area of insertion is cleaned and coved with a sterile dressing prior to discharge

After the Temporary Dialysis Catheter Placement radiology procedure:

What is to be expected after the Temporary Dialysis Catheter Placement radiology procedure?

• Some mild bleeding or oozing near the insertion site (spotting on the dressing) is expected
• There may be some bruises around the insertion site

When do you need to call your Physician?

Following the Temporary Dialysis Catheter Placement radiology procedure, contact your physician if you have the following:

• Fever or chills
• Significant leaking of blood near the site (though, a small amount of dried blood after the procedure is expected)
• Significant pain or swelling near the catheter insertion site
• Redness or soreness at the insertion site

What Post-Operative Care is needed at Home after the Temporary Dialysis Catheter Placement radiology procedure?

Following the procedure, at home one should:

• Avoid pulling on or moving the catheter
• Avoid any activity that can potentially cause displacement of the catheter
• The healthcare provider may impose some lifting restrictions, while the catheter is in place
• Avoid showering for 24 hours
• After 24 hours, cover the dressings over the insertion site with a clear plastic wrap
• Avoid bathtubs or hot tubs while the catheter is in place
• The dressing surrounding the catheter should be changed at each dialysis session

If the catheter is dislodged (or comes out):

• Lay down
• Use your hand to apply firm pressure over the site, where the catheter was placed
• Call 911, or an ambulance, or your local emergency number

How long does it normally take to fully recover, from the Procedure?

The skin at the insertion site may be sore for 1-3 days.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Temporary Dialysis Catheter Placement radiology procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Temporary Dialysis Catheter Placement radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Temporary Dialysis Catheter Placement procedure is performed.