Tunneled Dialysis Catheters
What is a Tunneled Dialysis Catheter?
Many patients who develop severe kidney failure will need dialysis for a period of time, whether for days, months or for years. The work of the kidneys is to rid the body of waste chemicals, and when the kidneys fail, this must be done by dialysis.
Hemodialysis (dialysis of the blood) is done by removing blood from a vein, running the blood through a filtering machine, and returning the filtered blood to the bloodstream. If patients are expected to need dialysis for years, then usually a surgery will be done on a large vein in the upper arm, but the majority of people receiving hemodialysis will have a tunneled dialysis catheter for at least a few months.
A tunneled catheter has two inner channels, one for removing the blood to the machine and the other for returning blood to the bloodstream. The catheter usually enters the skin below the collar bone (clavicle) and travels under the skin to enter the jugular vein, with its tip in the very large vein (the vena cava). This type of catheter is intended for long-term use (up to many months or even years). The catheters are designed with a cuff that resides under the skin, to make it more secure from being pulled out and to prevent infection.
How should I prepare?
There is no special preparation required. Be sure to inform the interventional nurse or radiologist of any allergies to medications or to latex gloves.
How is the procedure performed?
The procedure will be done in a special procedure room, on a fluoroscopy table where real-time X-ray imaging can be done to make sure the catheters are correctly placed. You will be asked to remove clothing above the waist and wear a gown. You will lie flat on your back. One dose of an intravenous antibiotic will be given at the start of the procedure. Strict sterile technique will be used.
The skin will be cleansed with antiseptic, and a local anesthetic given. Ultrasound is used to find the needle puncture site for the appropriate vein, and a wire is placed through the needle into the vein. The tunneled catheter will enter the skin at a distance from the initial puncture site, so a second injection of local anesthetic and a small skin nick are made, and the catheter is placed from there under the skin to connect with the first puncture site, and then the catheter is placed into the large vein. The initial puncture site will be closed with either a suture or skin adhesive (glue) or both. The outside end of the tunneled will be attached to your skin with a suture, and covered with a dressing.
What will I experience during and after the procedure and how will I get the results?
Local anesthetic stings at the first moment of injection, but you should only feel pressure after that. You will need to keep the catheter covered with plastic wrap while showering. Do not swim or immerse the catheter in water. The catheter needs to be flushed with a blood thinner after every use. When the time comes, it must be removed by a physician.
Call your physician if the catheter malfunctions, if there is bleeding or redness or swelling of the skin around the catheter, or if you develop a fever.
The interventional radiologist will determine that the catheter has been placed correctly. At each use of the catheter, your health professional will determine that the catheter is functioning by aspirating blood from the catheter before injecting medicine.
What are the benefits and risks?
If kidney function is expected to recover in a relatively short time (a few months) then a surgery on the veins of the arm can be avoided by using a dialysis catheter. In the case where kidney function is not expected to recover, then a dialysis catheter may be necessary while waiting for the surgery on the arm veins to take effect.
Any procedure that involves placing a catheter within blood vessels carries certain risks, such as bleeding and bruising, damage to the blood vessel, or infection. Immediately call your physician if any of the following occur:
- The catheter can become infected if it is not handled properly, or if there is a bloodstream infection. This may become apparent by redness and swelling around the catheter or unexplained fevers that do not respond to antibiotics.
- The catheter may become dislodged, and need to be replaced.
- The catheter may become clogged or narrowed by blood clot, and need to be exchanged for a new one. This usually becomes apparent when the dialysis takes much longer than usual.
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