Hemodialysis requires access to blood vessels capable of providing blood flow to and from the dialysis machine. Immediate hemodialysis access should be straightforward, available for immediate use, and have minimal complications in the short term (days to weeks). A large bore double lumen non-tunneled catheter (tube) is most often used when an immediate need for hemodialysis arises.
If dialysis for more than a week or so is likely, a cuffed, tunneled catheter should be used instead. Cuffed, tunneled catheters can also be placed for patients with chronic kidney disease who require dialysis, but do not have a functional permanent vascular access.
Dialysis catheters usually have at least two lumens attached to two ports (blue and red colored). By convention. The continuous blood path made possible by the dual lumen design allows rapid blood flow. The catheter is placed under conscious sedation (through an IV, not with a tube down your throat or general anesthesia). The procedure takes about 45 minutes. A small “nick” is made at the entrance site/access site of the catheter into the neck vein (typically, rarely the groin vein) and the tip is placed close to the heart. The catheter is then tunneled under the skin where a cuff helps prevent bacteria and fluid from entering the body. Two stitches are placed and can be removed after 5 days once the cuff is incorporated into the tissues. If the catheter is used for long periods of time it may begin to malfunction. The catheter is typically removed easily over a wire, and a new one is inserted with minimal discomfort.