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What Are MIIPs? / Hemodialysis Access
My kidneys are not working – what now?
The kidneys are organs that filter toxins and excess water out of your blood. If your kidneys stop working, a machine can filter your blood for you - this is called hemodialysis, or dialysis for short. Some people need hemodialysis for a short time, while others need it permanently.
How does hemodialysis work?
During hemodialysis, the dialysis machine draws the blood from your body through plastic tubing, filters and cleans it, and then returns the cleaned blood to your body. The blood flows like this:
Your body > plastic tubing > dialysis machine > plastic tubing > your body.
How does the dialysis machine access my blood?
The hemodialysis machine accesses the blood through your blood vessels through plastic tubes. Regular IVs are too small to draw off enough blood for hemodialysis. Larger IV tubes, or catheters, can be used for hemodialysis. There are 2 types of hemodialysis catheters: non- tunneled and tunneled.
Non-tunneled catheter
- Inserted directly into a large vein, usually in your neck
- Does not require surgery
- Lasts weeks - temporary
Tunneled catheter
- Travels just under the skin for several inches before inserting into a large vein, usually in your neck
- Does not require surgery, placed by a MIIP
- Lasts months - temporary
- Lower risk of infection because the tube is tunneled
People who expect to be on hemodialysis long term need more permanent access. There are
two types of permanent hemodialysis access: arteriovenous fistula and arteriovenous graft.
Arteriovenous (AV) fistula
- Direct connection is made between an artery and a vein, usually in the arm
- Requires surgery
- Lasts years
- A tube under the skin is used to connect an artery and a vein indirectly, usually in the arm
- Requires surgery
- Lasts years
A hemodialysis catheter is the best option for hemodialysis access (as opposed to permanent access) if:
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You are too sick to undergo surgery
-
You need urgent hemodialysis and do not have time to undergo surgery
-
You need urgent hemodialysis and your existing AV fistula or graft is not working
You need hemodialysis only for the short term
How is a tunneled catheter placed?
After injecting numbing medicine into your skin, your doctor will make a small nick at the base of your neck and one in your upper chest. They will use ultrasound to access the vein in your neck. They will then thread, or “tunnel,” the catheter under the skin in the chest to the neck and place it into the neck vein. Finally, your doctor will look with X rays to make sure that the catheter is in the right place, with the tip near the heart. The tunneled part of the catheter has a small cuff around it like a collar that helps keep it from falling out.
A tunneled catheter has these advantages over a non-tunneled catheter:
- Less risk of infection
- Less risk of falling out
- Can stay in place longer
- Can be hidden under a shirt
What are the side effects and possible complications of a tunneled catheter placement?
Risks of hemodialysis catheter placement are low. They include bleeding, infection, and damage to surrounding tissues. During the procedure, you should not feel any pain. Your doctor will numb your skin and you may have moderate sedation. Your doctor will discuss all risks and benefits prior to the procedure.
When you get more permanent hemodialysis access or no longer need hemodialysis, your tunneled catheter can be removed. After numbing the skin around the catheter, your doctor will loosen the tissue around the catheter and then pull it out.
For more information on tunneled catheters and hemodialysis access:
- https://www.kidney.org/atoz/content/hemoaccess
- http://esrdncc.org/wp-
content/uploads/2014/07/AAKFUnderstandingYourHemodialysisOptions.pdf
- http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/vascular-access-
for-hemodialysis/Pages/index.aspx
- https://vascular.org/patient-resources/vascular-treatments/dialysis-access