Rapid access for emergency dialysis.

Vascular access for acute hemodialysis or ultrafiltration in critically ill patients frequently requires cannulation of large-caliber veins. Repeated cannulation of these vessels present a finite risk of hemorrhage or hematoma. A teflon catheter introducer sheath system (TIS) allows for repeated use of the central circulation, requires only one major vascular entry, and can be adapted for either hemodynamic monitoring or emergency hemodialysis. Forty-six acute hemodialysis have been performed in 25 critically ill patients who have had TIS in place for hemodynamic monitoring. Dialysis was performed by inserting a femoral dialysis catheter through the TIS in place of the Swan-Ganz catheter. We have had no complications using the approach for emergency hemodialysis, and adequate dialysis was accomplished.