Some patients require urgent dialysis for unexpected kidney failure or kidney failure that was not known about.

There are type types of dialysis access. One is called a ‘vascath’, which is done in the hospital under local anaesthetic and is a large catheter that goes straight through your skin into a large vein in the neck, shoulder or groin. Vascath provides the ability to perform dialysis for around 7-10 days, as the lines tend to get infected if left in for longer than ten days.

A more permanent dialysis catheter solution involves a ‘tunnelled’ dialysis catheter in an operating theatre using an X-ray machine. The catheter pierces the skin on the chest wall above the nipple and runs under the skin over the collar bone and then into the vein of the neck (or sometimes the shoulder). Running the catheter directly under the skin makes it less prone to causing bloodstream infections. The procedure takes 30 minutes and is a low-risk procedure. These catheters can stay in for years; some are still functioning at the three-year mark!

There are a few downsides to using tunnelled dialysis catheters:

1. The catheter tubing that is accessed for dialysis sits on the chest wall and can be cosmetically frustrating
2. The catheters can cause scarring of the large veins in the chest and neck. Over time, this scarring can cause blockages in the veins, leading to swelling and needing to move the catheter to a different location. Blockages of the veins of the chest make fistula creation in the armless viable
3. The catheters can cause blood clots in the veins of the chest, which places patients at risk of pulmonary emboli
4. When inserting the catheter, the lining of the lung can be damaged, causing air to form around the lung and collapse some of the lung (pneumothorax)
5. These catheters can malfunction, meaning that dialysis occurs slowly or not at all, and the catheter can need to be replaced.