Restarting Dialysis After Catheter Insertion
Dialysis can be restarted immediately after catheter insertion if clinically necessary, though waiting 24-48 hours is preferred when possible to minimize bleeding and mechanical complications.
Immediate Use vs. Delayed Use
For urgent dialysis needs, newly placed catheters can be used immediately after insertion. 1, 2 The evidence shows that acute dialysis catheters are specifically designed for immediate vascular access in patients requiring urgent hemodialysis. 3
When dialysis is not immediately urgent, waiting 24-48 hours after catheter placement is recommended to allow the insertion site to stabilize and reduce bleeding risk. 4 This delay period is particularly important for patients with:
- Elevated international normalized ratio (INR >1.5) 5
- Low platelet counts 5
- Low hemoglobin levels 5
- Recent anticoagulation interruption 4
Special Considerations for Peritoneal Dialysis Catheters
For peritoneal dialysis catheters, the optimal approach is to wait 10-14 days after placement before initiating full-volume dialysis. 1 This allows proper healing of the tunnel and exit site.
If peritoneal dialysis must be started within 10 days of catheter placement, use low-volume supine dialysis initially to minimize complications such as fluid leakage and catheter migration. 1, 6
Technical Approach for Immediate Use
When immediate hemodialysis is required through a newly placed catheter, ensure adequate blood flow rates (≥200-300 mL/min) can be achieved before proceeding with the dialysis session. 1, 3
Use strict aseptic technique for the first catheter access, including surgical masks for both staff and patient, and sterile gloves for all connection procedures. 1
Monitor the catheter exit site closely during the first dialysis session for signs of bleeding, hematoma formation, or catheter malposition. 4
Common Pitfalls to Avoid
Do not assume that the 48-hour pre-insertion dialysis interruption requires an equivalent waiting period post-insertion. The pre-procedure interruption was for bleeding risk management during insertion, not a requirement for post-insertion timing. 5
Never delay urgent dialysis for catheter "maturation" when the patient has life-threatening hyperkalemia, severe acidosis, or volume overload requiring immediate intervention. 3, 2 Acute catheters are specifically designed for immediate use in these scenarios.
Avoid using excessive negative pressures (>-250 mmHg prepump pressure) during the first dialysis session, as this may dislodge the catheter or cause bleeding at the insertion site. 1
Do not restart therapeutic anticoagulation (heparin, warfarin, or DOACs) for 24-48 hours after catheter insertion if the patient was on anticoagulation therapy, as this significantly increases bleeding risk at the insertion site. 4