What is a hemodialysis catheter?
A hemodialysis catheter, or dialysis catheter, is a plastic catheter that can be used for hemodialysis. It is usually located in the upper chest (on either the right or left side). The catheter is tunneled under the skin and inserted through the internal jugular vein (at the lower part of the neck).
What is it for?
Hemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, hemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.
Common causes of kidney failure include:
High blood pressure (hypertension)
Kidney inflammation (glomerulonephritis)
Blood vessel inflammation (vasculitis)
Kidney cysts (polycystic kidney disease)
You require dialysis because your kidneys don’t work. During hemodialysis, your blood is removed and passed through a machine that removes toxins from your blood, then the blood is returned to you.
What are the risks?
Most people who require hemodialysis have a variety of health problems. With a hemodialysis catheter, but the main risk is the access site itself.
Access site complications can be potentially dangerous ― such as infection, narrowing (stenosis) or ballooning of the blood vessel wall (aneurysm), or blockage ― can impact the quality of your hemodialysis.
A hemodialysis catheter is usually not a permanent way to perform hemodialysis because of the above potential complications. As soon as another type of access is made and ready for use, like an arteriovenous fistula or graft, the catheter can be removed.
Follow your dialysis team’s instructions on how to check for changes in your access site that may indicate a problem.
How is a hemodialysis catheter placed?
The procedure is performed at El Camino Hospital in the catheterization lab also known as the “cath lab.” An entire team will be taking care of you during the procedure including a radiology nurse, a radiology technologist and the physician. In the procedure room, the nurse will help you lay on an exam table. You will be connected to heart rate, blood pressure and oxygen saturation monitors. Medicine may be given to relax you through your IV called moderate, also known as “twilight,” sedation. Your procedure area will be prepped and sterilized. A numbing medicine will be injected into the area (local anesthetic). Using an ultrasound, the large vein in your neck called the internal jugular vein is visualized. A needle followed by a guidewire is then passed into this vein. Then using x-ray (fluoroscopy) guidance the guidewire is maneuvered to the large central vein in your chest called the superior vena cava. Once the guidewire is in good position, the hemodialysis catheter is slid over the guidewire, replacing the guidewire. The hemodialysis catheter is then tunneled just under your skin for a few inches below your collarbone. This tunneling helps anchor the catheter in place. The tube exiting your skin will be temporarily sutured in place and your initial puncture site will be sealed with skin glue closed. After completion, your dialysis catheter and procedure site will be securely dressed and bandaged with a water sealed dressing.
The procedure time usually takes about 15-20 minutes. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.
What can you expect after the procedure?
After the procedure you will go to the post surgical area for recovery where we will be able to monitor your vital signs and the site of the procedure. In general, you will be there for about 30-60 minutes. We want to be sure you do not have any problems before you go home.
You will be able to eat and drink right after the procedure. You also will be able to see your family members soon after the procedure. If you feel well enough, you will be able to go home.
At home, we recommend that you take it slow the remaining day of the procedure. You should not drive, operate heavy machinery or consume alcohol until the following day after the procedure, if you received sedation.
How long does it take to recover?
Most patients should be able to return to their normal activities the day after the procedure.
We recommend no contact sports or extraneous activity for a period of approximately 1 week post procedure to minimize the chance of bleeding.
Care at the procedure site:
During the insertion procedure, a small incision was made in the lower neck to insert the catheter into your vein. The incision was closed with internal sutures and skin glue. Therefore, the incision is protected and you do not need a dressing. The glue will fall off by itself in 5-10 days – just leave it alone.
The catheter passes into the body at the upper chest. This insertion site is where it passes through a “tunnel” or “tract.” There is a sterile dressing over the insertion site of the catheter. This dressing should be changed if it gets wet or bloody. Otherwise, the dressing will be changed every time you have dialysis.
Can I take a shower with the catheter in place?
Yes. Initially it should be covered with plastic. However, after 2 weeks you can get the site wet. After contact with the water, the tube site should be dried off with a towel and a new dressing should be applied.
When can your dialysis catheter be used?
Your dialysis catheter can be used right away, but it often doesn’t work that well in the first or second dialysis session. No one knows exactly why, but usually it will work very well by the third session. Do not worry if you hear that the flow in your catheter is lower than expected during the first week. This occurs often.
What type of dialysis catheter was placed?
We place “tunneled” dialysis catheters (“TDC’s”) for our patients. These catheters run beneath the skin before they enter the vein. There is a Dacron “cuff” on the catheter under the skin and it holds the catheter in place by both friction and also by letting some of your healing tissue penetrate the cuff. Therefore, you may not need any sutures to keep your catheter in place, though we often place a suture to make sure the catheter doesn’t become dislodged. This suture can be removed after the first month.
In our practice we use two types of tunneled dialysis catheters and they work equally well:
The “Palindrome” tunneled dialysis catheter (manufactured by Covidien).
The “NextStep” tunneled dialysis catheter (manufactured by Arrow-Teleflex).
What should I watch for?
You may be sore after the procedure, but this should not get worse and should subside within 2-3 days. During this time, you may take a non-steroidal anti-inflammatory medication such as Ibuprofen (Motrin, Advil), Naproxyn (Aleve), Acetaminophen (Tylenol), or other similar over-the-counter medications. If you develop sudden pain or new swelling, call our office (650) 404-8445 or go to the emergency room if after 5pm or on the weekend.
How long can the dialysis catheter stay in place?
The dialysis catheter can stay in place as long as you need it. However, it should be removed when you no longer need it, to avoid the risk of an unnecessary infection or formation of blood clots or scarring in the veins. Please call us when you no longer need the dialysis catheter (650.404.8445).
How is the dialysis catheter removed?
The dialysis catheter can be removed with a simple procedure that is performed in the office with local anesthesia. The skin is cleansed and a local anesthetic is injected, then the Dacron cuff is freed from the tissues beneath the skin so that the catheter can be removed. The procedure takes only about 5 minutes.
When should you call your physician?
Fever or chills > 101.5 F
Worsening of redness or worsening of pain in the procedure area
New arm swelling
Problems when using the dialysis catheter
Leakage of blood from the catheter (if after hours, you will need to go to the Emergency Room)
You can reach your Interventional radiologist at 650-404-8446
If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may shower 24 hours after the procedure.
You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
You can resume your normal diet recommended by your nephrologist. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.
While this is controversial, no one really has a good reason why you cannot shower with your catheter. So we suggest that you do NOT shower the day of the procedure, but can shower the next day as long as you try to keep the catheter insertion site dry while you shower for the first two weeks. During this time you should not soak the catheter or the insertion site in water (eg. bath and swimming pool).
During the first 2 weeks you should cover your dialysis catheter with plastic while you take a shower.
After 2 weeks, there should be healing around the dialysis catheter, so if it gets wet it is not a problem. Just blot the site dry and place a new dressing.
If the dressing gets wet during shower, dry the area around the catheter and apply a new dressing.