• Tunneled Dialysis Catheter Placement

    Definition

    Tunneled dialysis catheter placement is the positioning of a tube from the surface of the skin to a major vein. The tube is placed in a path created under the skin to help keep it secure.
    The catheter has a double tube with separate entries or access ports. During dialysis, the blood leaves the body through a red access port, passes through the dialysis device, and returns through a blue access port.

    Reasons for Procedure

    A catheter eliminates the need for multiple needlesticks at each dialysis visit. Each time a needle passes through the skin it has the potential to cause infection. Multiple needlesticks increase the risk of infection, cause damage to the blood vessels, and can be painful. Tunneled catheters also decrease the time of set up for treatment.
    The catheter allows quick access to blood flow to perform dialysis. Dialysis is a process that filters and cleans the blood when the kidneys can no longer do their job.
    Dialysis
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    Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Infection
    • Scarring and narrowing of the vein—venous stenosis
    • Injury to blood vessels or the right atrium of the heart
    • Excessive bleeding
    • Blood clots
    • Allergic reaction to the contrast material
    • Irregular heart rhythm
    • Rarely, air can enter the upper chest during catheter insertion causing a pneumothorax
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Blood and urine tests
    • Imaging tests to evaluate the kidneys
    • Electrocardiogram (EKG) to evaluate electrical activity of the heart
    Your doctor may recommend:
    • Arranging for a ride home after the procedure.
    • Arranging for help at home.
    • Stopping certain medications up to a week before the procedure.
    • Not eating or drinking at least 8 hours prior to the procedure.
    Talk to your doctor about any allergies you have and what medications or supplements you currently take.

    Anesthesia

    Local anesthesia will numb the area where the catheter is inserted. You may be given a sedative to help you relax.

    Description of the Procedure

    The skin from your neck to upper chest will be cleaned. An ultrasound and x-rays using contrast material will help the doctor locate the vein that is being used. It will also help the doctor see that the catheters are in the correct place.
    A small incision will be made in the lower neck. The doctor will enter the jugular vein in the neck with a needle and pass a small guidewire into the vein. The guidewire will be passed down the jugular vein, to a larger blood vessel called the vena cava.
    A second incision will be made in the chest below the first incision. The doctor will created a tunnel just under the skin between the first and second incisions. The flexible dialysis catheter is then passed from the second incision, through the tunnel, to the first incision site, where it is passed over the guidewire and into its final position. The guidewire is removed from the blood vessels. The other end of the catheter will remain outside of the body, extending through the second incision. The doctor will make sure that blood is flowing in the catheter.
    Correct catheter placement postitioning can be confirmed with x-rays. Once in place, the catheter will be secured with stitches. Some catheters have a cuff that sits in the tunnel under the skin. This cuff helps keep the tube secure and free of infection. The first incision will be closed. It may be closed with stitches, tape, or a type of medical glue. The second incision will be stitched around the catheter to help it stay in place. Both areas will be bandaged.

    How Long Will It Take?

    Less than one hour

    Will It Hurt?

    Local anesthesia will prevent pain during the procedure. There will be some discomfort over the area for a few days. Pain and discomfort after the procedure can be managed with medications.

    Post-procedure Care

    At the Care Center
    Blood pressure, pulse, and breathing will be monitored in a recovery room. Recovery may also include:
    • Pain medications
    • Antibiotics to prevent infection
    During your stay, the healthcare providers will take steps to reduce the chance of infection, such as:
    • Washing their hands.
    • Wearing gloves or masks.
    • Keeping your incisions covered.
    There are also steps you can take to reduce your chances of infection, such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same.
    • Reminding your healthcare providers to wear gloves or masks.
    • Not allowing others to touch your incisions.
    At Home
    Recovery at home can take 2-4 weeks. Bruising and swelling should last a few days. Certain strenuous physical activities will be limited for the first few weeks.

    Call Your Doctor

    Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
    • Signs of infection, including fever or chills
    • Increased redness, pain, swelling, or unusual discharge at the insertion sites
    • Swelling or pain in either arm
    • The catheter gets wet
    • You accidently kink one or both of the catheters for more than a minute
    • The catheter moves or falls out
    • Irregular heart rhythm
    If you think you have an emergency, call for emergency medical services right away.

    RESOURCES

    National Institute of Diabetes and Digestive and Kidney Disorders http://www.niddk.nih.gov

    National Kidney Foundation https://www.kidney.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Kidney Foundation of Canada https://www.kidney.ca

    References

    Ash SR. Advances in tunneled central venous catheters for dialysis: Design and performance. Semin Dial. 2008;21(6):504-515.

    Hemodialysis catheters: How to keep yours working well. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/hemocatheter. Accessed March 8, 2016.

    Interdisciplinary clinical practice manual, infection control, vascular access device (VAD) policy, adult. National Implementation of the Comprehensive Unit-based Safety Program to Eliminate Health Care-associated Infections website. Available at: http://onthecuspstophai.org/wp-content/uploads/2012/04/AppendixHHCareofPatientwithHemodialysisCatheter.pdf. Updated May 1, 2007. Accessed March 8, 2016.

    Vascular access for hemodialysis. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/vascular-access-for-hemodialysis/Pages/index.aspx. Updated July 2014. accessed March 8, 2016.

    Vascular access procedures. Radiological Society of North America Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?PG=vasc%5Faccess. Updated August 5, 2013. Accessed March 8, 2016.

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