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.
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.
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Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
Your doctor may do the following:
Your doctor may recommend:
Talk to your doctor about any allergies you have and what medications or supplements you currently take.
Local anesthesia will numb the area where the catheter is inserted. You may be given a sedative to help you relax.
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 create 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.
Less than 1 hour
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.
Blood pressure, pulse, and breathing will be monitored in a recovery room. Recovery may also include:
During your stay, the healthcare providers will take steps to reduce the chance of infection, such as:
There are also steps you can take to reduce your chances of infection, such as:
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.
Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
If you think you have an emergency, call for emergency medical services right away.
National Institute of Diabetes and Digestive and Kidney Disorders
National Kidney Foundation
The Kidney Foundation of Canada
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 14, 2018.
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 January 2018. Accessed March 14, 2018.
Vascular access procedures. Radiological Society of North America Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?PG=vasc_access. Updated May 1, 2017. Accessed March 14, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board James P. Cornell, MD Last Updated: 3/8/2016