![]() Placement of a new dialysis catheter is invariably necessary for starting extracorporeal RRT in the emergency or acute settings (with the exception of patients with end-stage renal disease who already happen to have a catheter in situ). ![]() If the superficial cuff placement is too deep, serous fluid may collect in the space outside of the cuff, leading to skin irritation and infection. Placing the deeper cuff outside the rectus muscle may lead to less tissue ingrowth, increasing the likelihood of leakage and herniation. With the use of a Tenckhoff catheter with two cuffs, the deeper cuff should rest within the pre-peritoneal space in the rectus sheath, and the superficial cuff should lie 2 to 3cm medial to the superficial wound. The borders of the rectus muscle are preferred insertion sites, away from the paths of the superficial and inferior epigastric arteries. When correctly placed, they should traverse the anterior abdominal wall with the distal tip resting superficial to the visceral peritoneum and deep to the parietal peritoneum, pointed in the direction of the pelvis. Femoral vein catheters should be at least 20cm in length so that the tip of the catheter passes through the common iliac vein and reaches the inferior vena cava.īy contrast, peritoneal dialysis catheters target the intraperitoneal space rather than a vascular structure. The subclavian vein is less commonly used in the acute or emergency setting, as flow rates may be more reduced, and this site carries associations with subsequent subclavian vein stenosis this could make the placement of a tunneled cuffed catheter or a surgical arteriovenous fistula more difficult should the patient go on to require this. ![]() For catheters placed through the internal jugular vein or subclavian vein, the optimal tip location is at the junction of the superior vena cava and right atrium, and catheters around 15cm in length are appropriate. Tunneled cuffed catheters are inserted under fluoroscopic guidance into the subclavian vein. Potential placement sites include the internal jugular vein, subclavian vein, and femoral vein. Non-tunneled catheters for short-term extracorporeal RRT are preferentially inserted under ultrasound guidance, as this allows subcutaneous structures to be visualized and reduces the complication rates, but they can also be placed using only surface anatomical landmarks. ![]()
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