temporary dialysis catheter placement

[Hamhock]

There's a thread over in the EM forum about the NHS in the UK. The topic was a bit off the rails for a while and the topic of temporary dialysis catheter placement came up.

I was originally EM-trained (after starting IM). During my EM residency, we were trained to place all emergent dialysis catheters and often placed 'just urgent' dialysis catheters in the ICU. Surgeons did this also. Some of the ICU attendings/fellows did too.

However, I never came across a Nephrology attending place a catheter or even a fellow. I once supervised a fellow interested in learning to place femoral catheters, but have not since come across even the implication that a nephrologist would place the catheter before CRRTx or iHD.

Is my experience unusual? Do nephrologists place temporary catheters in the community? In academic centers?

What kind of training is common during nephrology fellowship?

Thanks for educating me (and other EM docs/CCM docs).

HH

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[drfunktacular]

I am sure it varies quite a bit but in my internal medicine program, the nephrology fellows were quite eager and adept at placing their own dual-lumen catheters in the ER, ICU, floor, etc. The PCCM fellows would also do it in ICU patients, and IR would do it in less urgent situations during daytime hours. In community practice where I am it seems to be done mainly by proceduralists (IR/surgery)


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[Raryn]

There's a small number of nephrologists trained in "interventional nephrology" that place not only temporary but tunneled dialysis catheters as well as even doing the occasional interventional fluoroscopic procedure on a fistula. I've met one.

Of the remainder, they should all theoretically be able to place a temporary dialysis catheter (we learn how to do it in IM residency, which they all did before fellowship) but I have never seen nor heard of a nephrologist obtaining their own access. Everywhere I've been, it's the EM, IM/ICU, Surgery/ICU, or IR placing all access for the nephrologists.