Anaesthesia - paediatric haemodialysis catheter insertion
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This guideline is to assist in standardising the size, placement and type of catheter to be used. There are 2 types of haemodialysis catheters:
- uncuffed for temporary dialysis; and
- cuffed for long term dialysis.
The nephrologist requesting the catheter insertion will decide whether the catheter will be cuffed or uncuffed. Uncuffed catheters are inserted percutaneously and are usually inserted by an anaesthetist or PICU staff. Cuffed catheters are tunnelled and usually inserted by paediatric surgery.
Size of catheter
In general, the bigger catheter (French gauge) the better to achieve adequate blood flow rates. The following is a guide to catheter size selection. Haemodialysis catheters are double lumen. We are transferring to a single supplier so all catheters will be Medcomp catheters. Table 1 below is for stocked catheter sizes. (See Historic Stock details below for prior non-medcomp stock/sizes if required).
Table 1. Catheter sizes
|<10kg||T74M 7 FR x 10cm (straight)||<10kg||SL18P 8 FR x 18cm (straight)|
|10-20kg||SL12P 8 FR x 12cm (straight)||10-20kg||SL18P 8 FR x
MSL24P 8 FR x 24cm (straight)
|20-30kg||XTP94JS 9 FR x 12cm (raulerson -
XTP96IJS 9 FR x 15cm (raulerson - curved)
|20-40kg||MC101042P 10 FR x 18cm (straight) (14cm tip to cuff)|
|XTP95MT 9 FR x 15cm (straight)|
|>30-50kg||XTP114JSE 11.5 FR x 12cm
XTP116IJSE 11.5 FR x 15cm (pre-curved)
|>40kg||SL28PCE 12.5 Fr x 28cm (pre-curved)|
|XTP118MT 11 FR x 20cm (straight)||MC101243 12.5 FR x 24cm (straight) (19cm tip
SL28E 12.5 FR x 28cm (straight) (23cm tip to cuff)
SL32E 12.5 FR x 32cm (straight) (27cm tip to cuff)
|>50kg||DFST136CEE 13F x 15cm
DFST138MTE 13FR x 20cm (straight)
|>60kg||HFS24PCE 14.5 x 24cm
HFS28PCE 14.5 x 28cm (precurved)
|HFS32E 14.5 x 32cm (straight)
HFS36E 14.5 x 36cm (straight)
Location of the catheter
Where possible right internal jugular vein should be used. The left internal jugular vein undertakes a longer route and adequate blood flow is less consistent. Subclavian vein should be avoided as this is associated with a significant risk of subclavian stenosis which will compromise future fistula creation. Femoral vein may be utilized for uncuffed catheters.
Catheter tip position
Tip of the catheter should ideally be located at the SVC/RA junction when the right internal jugular vein is used. If the tip of the catheter is not in the distal SVC, sucking on the vein wall may occur rendering haemodialysis extremely difficult. If a femoral vein is used (uncuffed catheter), a longer catheter is required as the tip should lie in the inferior vena cava.
All catheters should be flushed with heparin (1000 units/ml) with the exact volume as indicated on the hub of the catheter. The volume of heparin will be different for the arterial and venous lumens.
Vascular imaging pre catheter insertion
In patients requiring long term haemodialysis catheter placement who have a past history of central venous catheter insertion, a doppler ultrasound of the neck veins should be considered prior to the procedure. Select patients may require non-contrast MR venogram pre insertion, at the discretion of surgical team.
Post catheter insertion
- Routine Imaging:
Position of uncuffed temporary catheters should be confirmed and pneumothorax excluded by CXR for Internal Jugular (and Subclavian catheters). Line tips need to be intrathoracic and should ideally lie at the RA/SVC junction. Catheters within the RA need to be pulled back to the RA/SVC junction.
Xrays are not routinely required for femoral catheters. However, if a femoral line is difficult to insert, or if blood is not freely aspirated back from both lumens immediately after insertion a lateral abdominal XR should be done to exclude line placement in an ascending lumbar vein (this is more common on the left). (Cuffed catheter line position is confirmed via fluoroscopy at time of insertion).
- Measurement of the distance from catheter hub to exit site should be performed routinely for all cuffed catheters at time of first dialysis run and documented in patient chart/ dialysis access management plan.
- Heparin free dialysis recommended for patients having dialysis same day as any catheter insertion.
- Suture removal for cuffed tunnelled lines - insertion site 1 week post, exit site 2 weeks post. To be done by haemodialysis staff. Document this is done in patient chart/ dialysis access management plan.
|QUINTON PERMACATH 8834
369001 10Fr x 28cm
Tip to cuff 13cm
|QUINTON PERMACATH 8817
748001 12Fr x 36cm
Tip to cuff 19cm
|QUINTON PERMACATH 8817
749001 12Fr x 40cm
Tip to cuff 23cm
|QUINTON PERMACATH 8831
692001 12Fr x 45cm
Tip to cuff 28cm
|Vas caths/Hemo caths (NO cuff)|
6.5fr x 10cm
10fr x 12cm (CVD)
11.5 x 13.5 cm (CVD)
11.5Fr x 16cm ( CVD)
|Bard Niagara slimcath
12fr x 15cm
Did you find this information helpful?
- Date last published: 24 June 2016
- Document type: Clinical Guideline
- Services responsible: Paediatric Anaesthesia, Paediatric Nephrology, Paediatric Surgery
- Author(s): William Wong, Niall Wilton
- Editor: Michael Tan
- Review frequency: 2 years
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