Hemodialysis Catheter: Types Permacath Insertion & Care Guide

What Is a Hemodialysis Catheter and When Is It Needed?

A hemodialysis catheter is a soft tube placed into a large vein, usually in the neck, to enable blood access for dialysis. Unlike an AV fistula or graft, it connects directly to dialysis tubing, eliminating the need for needles at every session.

It is chosen when urgent or temporary access is needed, and no other option is clinically viable.

• Emergency kidney failure requires immediate dialysis access that a fistula cannot provide in time. Catheters can be used immediately after insertion and are routinely required in both emergency and subacute settings where AV fistula creation is not feasible in advance.
• It bridges the gap while a permanent access site matures after surgery. Tunnelled hemodialysis catheters are used long-term or while waiting for arteriovenous fistulas to mature, making them a critical transitional access option.
• Patients with exhausted vessel options rely on catheters as a last resort. A long-term dialysis patient who has had several failed fistulas may have no alternative but to have a central venous catheter placed for long-term use.
• It carries a significantly higher infection and mortality risk than a fistula. Infection rates in permanent catheter patients run approximately 10 times higher than in AV fistula patients, making infection the most critical long-term concern ^[1].
• A nephrologist evaluates whether a switch to a fistula remains possible at any stage. Patients without a fistula should ask their dialysis care team whether switching to a fistula or graft from catheter-based access would be appropriate for their case.

To choose the most appropriate access option, you need a clear understanding of the different types of dialysis catheters and their clinical use.

Types of Dialysis Catheter You Must Know

Haemodialysis catheters are classified into two main types: non-tunnelled and tunnelled, with selection based on the required duration of dialysis access.

Non-Tunnelled Hemodialysis Catheter

Non-tunnelled hemodialysis catheters are used when vascular access is required urgently, with the right internal jugular vein preferred, followed by the femoral vein in acute kidney injury. They are inserted directly through the skin without passing under subcutaneous tissue, enabling same-day placement in emergency settings. Non-tunnelled catheters are appropriate for temporary or short-term use only and must typically be exchanged every few days to one week.

Tunnelled Hemodialysis Catheter (Permacath)

Unlike non-tunnelled catheters, tunnelled CVCs travel under the skin and terminate away from the venous access site, allowing them to remain in place for weeks to months. The subcutaneous tunnel physically separates the skin entry point from the vein entry point, reducing bacterial migration into the bloodstream. The tunnelled cuffed catheter was developed so that the cuff forms a fibrous tissue barrier against infection, prevents displacement, and provides access stability.

Cuffed vs. Non-Cuffed Design

The presence of a cuff is the key structural distinction that determines how long a catheter can safely remain in the body. Cuffed catheters have a small ring beneath the skin where tissue grows over to hold the catheter in place and prevent it from dislodging over time. Interventional Initiative Non-cuffed catheters lack this protective seal and are therefore limited to short-term use of up to three weeks before infection risk becomes clinically significant.

Also read: SLED Dialysis: A Hybrid Approach to Kidney Failure Treatment.

Permacath Insertion: What to Expect Before, During, and After

Permacath insertion is a minimally invasive procedure performed under local anaesthesia, typically by an interventional nephrologist, and is usable for dialysis immediately after placement.

• Dietary and medication restrictions must be followed strictly before the procedure. Patients may be given either local or general anaesthesia; blood thinners and other medications should be disclosed to the treating physician well in advance of scheduling.
• Ultrasound and fluoroscopy guide the catheter to the correct position near the heart. Using both ultrasound and fluoroscopy, the catheter is placed from the chest through a sheath into the neck veins in a procedure lasting approximately 30 to 45 minutes.
• A subcutaneous tunnel is created to protect the catheter from infection and movement. The tunnelling under the skin, combined with the cuff’s tissue ingrowth, creates a bacterial barrier and keeps the catheter stable during routine dialysis sessions and daily activity.
• The catheter is ready for dialysis immediately after the procedure. The catheter can be used immediately after placement, with one to three hours of post-procedure monitoring before same-day discharge from the hospital or clinic.
• Post-procedure recovery focuses on activity restrictions and home care for dressings. Recovery at home can take 2 to 4 weeks, during which patients must avoid heavy lifting and strenuous activity and keep the incision covered to prevent infection.

Once your catheter is in place, consistent daily care becomes essential to reduce infection risk and keep your dialysis access safe and functional.

Also read: Best Dialysis Diet Tips for Better Kidney Health.

Hemodialysis Catheter Care: Preventing Infection and Show

Infection is the most serious long-term risk of a hemodialysis catheter, making consistent daily care a non-negotiable clinical responsibility for every patient.

• Exit site dressing must be kept clean and dry, and changed at least once per week. The CDC recommends applying antibiotic ointment to the catheter exit site after insertion and at each subsequent hemodialysis session during dressing change.
• Strict hand hygiene before and after touching the catheter is the first line of defence. Hand hygiene must be performed before and after palpating catheter insertion sites and before inserting, replacing, accessing, repairing, or dressing any intravascular catheter without exception.
• Yes, you can shower, but only with a waterproof cover securely placed over the dressing. Showering or bathing is permitted only when a clear, waterproof dressing that adheres firmly to the catheter site and surrounding skin is properly in place.
• The catheter should never be submerged; swimming and tub baths are completely prohibited. Patients must avoid submerging the catheter exit site in water at all times, as swimming and tub baths are prohibited due to the direct infection risk they create.
• Fever, redness, or discharge at the exit site requires immediate medical attention ^[2]. Patients should contact their hemodialysis unit immediately if they notice redness, warmth, pain, oozing or drainage from the exit site, swelling, or fever, along with any of these local symptoms.

Before you decide on a treatment plan, it is important to understand the cost range of dialysis catheters across different types and hospital settings in India.

Dialysis Catheter Price in India

Dialysis catheter costs in India vary by type, brand, material quality, and whether the device is for temporary or long-term use.

Here’s a tabular representation for a comprehensive view of dialysis catheter prices:

Note: Total treatment cost (including the centre or hospital insertion procedure) depends on the dialysis centre or hospital, the level of expertise, and the patient’s condition.