Tunneled Dialysis Catheter Placement
Definition
Tunneled dialysis catheter placement inserts a tube (catheter) under the skin and into a major vein.
The tube has two openings. The blood leaves the body through the red opening. It is filtered and cleaned through dialysis. The cleaned blood returns through the blue opening.
Reasons for Procedure
This procedure is done to allow quick access to blood flow to do dialysis. Dialysis is a process that filters and cleans the blood when the kidneys can no longer do this on their own.
People who have this catheter do not need to have multiple needlesticks at every dialysis visit. This lowers the risk of infection and damage.
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Possible Complications
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
- Excess bleeding
- Problems from anesthesia or contrast material, such as wheezing or sore throat
- Infection
- Blood clots
- Scarring and narrowing of the vein—venous stenosis
- Irregular heart rhythm
- A collapsed lung
- Injury to blood vessels or the heart
Things that may raise the risk of problems are:
- Smoking
- Alcohol use disorder (AUD)
- Chronic diseases, such as diabetes or obesity
What to Expect
Prior to Procedure
The surgical team may meet with you to talk about:
- Anesthesia options
- Any allergies you may have
- Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
- Fasting before surgery, such as avoiding food or drink after midnight the night before
- Whether you need a ride to and from surgery
- Tests that will need to be done before surgery, such as images of the kidneys
Anesthesia
The doctor may give:
- A sedative—you will feel relaxed
- Local anesthesia—the area will be numbed
Description of the Procedure
An ultrasound and x-rays using contrast material will be used to help locate the vein. It will also help put the catheters in place.
A small incision will be made in the lower neck. The doctor will access the jugular vein in the neck with a needle and pass a small guidewire into the vein. The guidewire will be passed to a larger blood vessel called the vena cava.
A second incision will be made in the chest below the first incision. A tunnel will be made 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. This is 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 can be checked with x-rays. 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 1 hour
Will It Hurt?
Pain is common in the first few days. Medicine and home care can help.
Post-procedure Care
At the Care Center
The staff may give you medicine to ease pain.
During your stay, staff will take steps to lower your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
You can also lower your chance of infection by:
- Washing your hands often and reminding visitors and staff to do the same
- Reminding staff to wear gloves or masks
- Not letting others touch your incisions
At Home
Recovery can take 2 to 4 weeks. You may need to ask for help with daily activities. Some physical activities may need to be limited during this time.
Call Your Doctor
Call the doctor if you are not getting better or you have:
- Signs of infection, such as fever or chills
- Increased redness, pain, swelling, or discharge at the insertion sites
- Swelling or pain in either arm
- A catheter that gets wet
- Accidently kinked one or both catheters for more than a minute
- A catheter that moves or falls out
- Changes in heart rhythm
If you think you have an emergency, call for medical help 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
https://www.canada.ca
The Kidney Foundation of Canada
https://www.kidney.ca
REFERENCES:
Hemodialysis. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis. Accessed September 16, 2020.
Hemodialysis catheters: How to keep yours working well. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/hemocatheter. Accessed September 16, 2020.
Vascular access procedures. Radiological Society of North America Radiology Info website. Available at: http://www.radiologyinfo.org/en/info.cfm?PG=vasc_access. Accessed September 16, 2020.
Last reviewed March 2020 by EBSCO Medical Review Board Shawna Grubb, RN Last Updated: 3/24/2021