Emergency Dialysis Catheter Insertion (IJV & Femoral)

Dialysis Catheter Insertion: Emergency Access

Advanced Vascular Access Techniques by Prof (Dr) Debabrata Mukherjee at Medanta – The Medicity, Gurugram.

Emergency Hemodialysis Access

In cases of sudden kidney failure or acute complications, immediate blood filtration is required. To facilitate this, a Central Venous Catheter (CVC) is inserted into a major vein. At Medanta, we prioritize safety by using real-time ultrasound guidance to minimize complications during the insertion of Internal Jugular (IJV) and Femoral catheters.

Choosing the Access Site

Feature	Internal Jugular (IJV)	Femoral Vein
Location	Side of the Neck	Groin / Upper Thigh
Infection Risk	Lower	Higher
Patient Comfort	Better (Full mobility)	Restricted (Bed rest required)
Duration	Up to 2-3 weeks	Emergency (3-5 days)

1. IJV Procedure

The internal jugular vein is the preferred site due to its straight path to the heart.

Sterilization & Local Anesthesia.
Ultrasound Guidance to visualize the vein.
Seldinger Technique (Guidewire insertion).
Dilation of the tract.
Insertion of the dual-lumen catheter.
Position confirmation (via Chest X-Ray).

2. Femoral Procedure

Chosen for rapid access during code-blue situations or if neck access is compromised.

Groin area sterilization.
Local numbing.
Needle puncture distal to the inguinal ligament.
Catheter placement and secure suturing.
Strict sterile dressing to prevent groin infection.

Safety & Complication Management

While life-saving, catheter insertion is performed with extreme care to avoid:

Pneumothorax: (Accidental lung puncture – minimized by Ultrasound).
Arterial Puncture: (Minimized by vessel visualization).
Thrombosis: (Blood clots within the catheter).
Infection (CRBSI): Managed with strict antibiotic locks and sterile handling.