Dialysis Shunt (Graft) Catheter

Dialysis catheter insertion

These catheters are also known as permcath, vascath, optiflow, and ash split catheter. These are placed during an outpatient surgery and can be used immediately following the procedure. You are usually allowed to go home approximately 1 1/2 hours following the surgery. If you have had any anesthetic for the surgery, you need to have someone to drive you home and be with you for 8-12 hours after the procedure. These catheters are often placed along with AV (arterio-venous) shunts or AV fistulas. Although they can be left in place as long as necessary, dialysis catheters are designed to be temporary. They are usually inserted in the right or left side of your upper chest/shoulder (underneath your collarbone), and you will not be allowed to get it wet as long as you have it. Keep your head up (don't lie down flat) for at least 4 hours after placement to reduce the risk of bleeding from the insertion site. There will be a sterile bandage covering it, which will be changed every time you have dialysis. Once the catheter is no longer required, you will need to call the office for an appointment to have it removed.

AV (arterio-venous) shunt

This is an implanted tube to which an artery and vein in your arm is attached. This provides a larger than normal volume of blood flow for effective hemodialysis. It is important for your physician to know if you are right­-handed or left-handed since an AV shunt is usually placed in the non-dominant arm. This is because the arm may not be used for taking blood pressures, for IV medications, drawing blood, or for needle sticks of any kind except for dialysis! It must be carefully protected so your risk of complication is kept as low as possible. AV shunts are placed during an outpatient surgery. You are usually allowed to go home approximately 1 1/2 hours following the surgery. You will also need to have someone drive you home and be with you for 8-12 hours after the procedure. Your shunt can be used for dialysis approximately 2 weeks following the procedure, after you have been given the "OK" by your surgeon. You will need to monitor your shunt daily for a pulse, and for signs of infection such as temperature elevation, redness or drainage, or increasing swelling. You can expect to have some pain and swelling immediately following the surgery. Keeping your arm elevated will help reduce the pain and swelling, both of which will gradually resolve over time. If you have any signs of infection, or if you "lose" the pulse in your shunt, you should contact your nephrologist as soon as possible. Dialysis catheters may be removed once your shunt has been used without complication for 2 weeks. You will need to call the office to make an appointment to have stitches removed, and again to have your dialysis catheter removed.

Outpatient surgery and procedures

Your procedure will be done in the hospital. The preparation for this is nothing to eat or drink after midnight the night before the procedure. You may take your essential medications such as blood pressure and heart medications with a sip of water the morning of your procedure. Continue to take your aspirin daily or as directed. If you take Coumadin®, it should be stopped 4 days before the procedure. If you take insulin, it is recommended you take only half of your normal dose the morning of the procedure.

Complications

Unfortunately, there are complications that can occur with any invasive procedure. These can include infection, pain, swelling and bleeding from the surgical site or dialysis needle insertion site. The most common complications that occur with dialysis access sites vary with the type of access placed.

Dialysis catheter complications are most often related to poor flow rates, and less often related to infection and thrombosis (blood clots clogging the catheter). Half of the catheters placed will no longer work after 6 months, and more than 90% will stop working by 1 year. Ideally, placing an AV shunt along with a dialysis catheter, and discontinuing the catheter as soon as possible reduces these complications.

AV shunt complications are most often related to thrombosis (blood clots) that forms within the shunt. You will know this has occurred if you can no longer feel a pulse (also called a "thrill") along the length of the graft. Only about 45% of AV shunts will continue to function after one year. When or if thrombosis occurs, an AV shunt thrombectomy (clot removal) can be performed as an outpatient surgery to re-open the graft. Sometimes a shunt will require revision, and sometimes a dialysis catheter will need to be replaced when the continuing function of the graft is in doubt. When shunts repeatedly fail, they are either moved to the upper arm or the opposite arm. In some cases the AV shunt has to be abandoned altogether and dialysis will be accomplished by the dialysis catheter.

A more rare but serious complication of placing an AV shunt is "vascular steal" or the "shunting" of blood flow away from the hand. This can cause permanent nerve damage and or paralysis of the affected hand if not treated urgently. Wearing a mitten at all times can help improve blood flow, but sometimes the AV shunt will have to be tied off or moved to another location. You should notify us immediately if your hand becomes white or bluish and is associated with severe pain, numbness, and/or loss of function.