Vascular access
Haemodialysis catheter: temporary and long-term
A haemodialysis catheter is a flexible tube placed in a large vein, usually in the chest or at the base of the neck, that allows dialysis to start straight away. There are two types: the temporary catheter (Shiley), for days or a few weeks, and the long-term catheter (Permcath), which runs through a tunnel under the skin and can stay in for months. Because it carries a higher risk of infection than a fistula, a catheter should ideally be a bridge to a permanent access whenever possible.
When a catheter is needed
- When haemodialysis must start urgently and there is no fistula or graft ready yet.
- While a fistula matures, or when a fistula or graft stops working and the patient needs haemodialysis.
- When there are no suitable veins and arteries for a fistula or graft.
- When a catheter is the best choice for the patient's treatment plan, such as dialysis expected for a short time or an upcoming transplant.
In Brazil, around a quarter of haemodialysis patients were using a long-term catheter in 2024, according to the Brazilian Dialysis Survey. Some of them could have had a fistula with earlier planning.
Temporary (Shiley) or long-term (Permcath): what is the difference
| Type | How it sits | For how long | When it is used |
|---|---|---|---|
| Temporary (non-tunnelled) | Goes straight into the vein, stitched to the skin | Days to a few weeks | Emergencies and hospital stays |
| Long-term (tunnelled, with a cuff) | Runs through a tunnel under the chest skin before entering the vein. A felt ring (cuff) bonds to the tissue and helps hold it in place and protect against infection | Months | While the fistula matures or when the catheter is the planned access |
Where the catheter is placed
The preferred vein is the right internal jugular, in the neck. It offers the most direct route to the heart and has fewer complications.
The subclavian vein, below the collarbone, is avoided when possible: a catheter there can narrow the vein and compromise a future fistula in the arm on the same side. The femoral vein, in the groin, is kept for specific situations, because it carries a higher risk of infection and of thrombosis of the vein where the catheter sits.
When the veins are narrowed (stenosis), especially in patients who have already had several catheters, alternative routes can also be used, such as the innominate vein (also called the brachiocephalic vein), the inferior vena cava through a translumbar approach and the transhepatic route. These sites should be reserved for experienced surgeons.
How the catheter is placed
- It is placed under local anaesthesia, sometimes combined with light sedation.
- The vein should be punctured under ultrasound guidance, which reduces complications.
- For long-term catheters, the position of the tip is checked with fluoroscopy (real-time X-ray).
- In someone who has never had a catheter, the procedure usually takes about 15 minutes. The catheter is tested straight after it is placed and can be used the same day.
- The procedure is done in an operating theatre with a C-arm (mobile X-ray) or in the catheter lab. Patients should arrive at the hospital or clinic fasting and, if placement goes without complications, go home straight afterwards.
Looking after the catheter
Day to day
- Keep the dressing clean and dry. The dressing should be changed by the dialysis team.
- In the shower, protect the dressing so it does not get wet, as advised by the team. A waterproof dressing is usually recommended. Never immerse yourself in water (swimming pool, sea or bath).
- Once fully healed, it is usually acceptable for a long-term catheter to be exposed in the shower. The exit site of a temporary catheter, however, must be kept dry at all times.
- The catheter is for haemodialysis only. It should not be used to take blood or give medicines unless the team advises it or in an emergency.
- Do not remove the dressing, do not touch the caps and keep the clamps closed.
- Wash your hands before any contact with the area.
Seek care the same day if
- you have a fever or chills, especially during or after a session;
- there is redness, pain, pus or discharge where the catheter leaves the skin;
- the catheter partly comes out, moves or bleeds;
- the arm, neck or face on the catheter side swells;
- you suddenly become short of breath.
Fever in someone with a haemodialysis catheter should be assessed the same day. A catheter-related bloodstream infection is serious and needs prompt treatment.
Most common problems
The most common are infection, at the exit site or in the bloodstream, and poor function, with low flow caused by a clot, by a fibrin sheath around the tip or by a change in position. Thrombosis and narrowing of the central veins can also occur, which may lead to oedema (swelling) of the arm and make future access harder.
Many of these problems are treated without changing the catheter. When it does need to be changed, this can be done through the same track or at another site. That is why keeping the catheter in place until it is changed can make the procedure easier.
Why plan for the catheter to come out
Studies link long-term catheter use to more infections and hospital admissions than a fistula. That is why, whenever an arteriovenous fistula or a graft is possible, the plan includes creating it and removing the catheter as soon as the new access can be used.
Removing a long-term catheter is a quick procedure under local anaesthesia that usually takes less than 5 minutes.
Frequently asked questions
Does having a haemodialysis catheter placed hurt?
The procedure is done under local anaesthesia. You may feel pressure and mild discomfort, but not severe pain.
Can I shower with a catheter?
Yes, with the dressing protected, ideally with a waterproof cover. Once fully healed, a long-term catheter can usually be exposed in the shower; a temporary catheter must always be kept dry. Immersion (swimming pool, sea or bath) is not allowed while you have a catheter.
How long can the catheter stay in?
A temporary catheter, from days to a few weeks. A long-term catheter can stay in for months while it works without complications, but ideally it should be used for as short a time as possible.
Can I have a fistula made while using a catheter?
Yes. When there are suitable veins, this is recommended. Planning takes into account the side where the catheter is.
Is a haemodialysis catheter the same as a chemotherapy catheter?
No. The haemodialysis catheter is wider, has two channels, one for blood to leave and one for it to return, and part of it stays outside the skin. The chemotherapy device, the port, sits entirely under the skin.
References
- Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164. doi:10.1053/j.ajkd.2019.12.001
- Schmidli J, Widmer MK, Basile C, et al. Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818. doi:10.1016/j.ejvs.2018.02.001
- Nerbass FB, Lima HN, Zawadzki B, Moura-Neto JA, Lugon JR, Sesso R. Brazilian Dialysis Survey 2024. Braz J Nephrol. 2026;48(1). doi:10.1590/2175-8239-JBN-2025-0112en
About the author
Dr. Pedro Mellucci is a vascular surgeon in Presidente Prudente, Brazil, dedicated to vascular access for haemodialysis and chemotherapy: fistulas, grafts and catheters.
Meet Dr. Pedro Mellucci →