About your tunnelled dialysis catheter Information for patients Sheffield Kidney Institute (Renal Unit)
You will have discussed with your doctor that your kidney condition means that you need to have regular dialysis. In order for this to happen, we need to fit a piece of equipment into your chest called a tunnelled dialysis catheter (sometimes called a tunnelled line). In this leaflet, we explain what this is, what it does, how we fit it and how you need to look after it. We hope that we will have answered all your questions but if, after reading this leaflet, you would like to know more or have some questions then please speak to a member of staff at the renal unit. We explain how to do this at the end of the leaflet. page 2 of 12
What is a dialysis catheter? A dialysis catheter is a long hollow tube that is made out of polyurethane. Polyurethane is a strong but flexible man-made plastic. A dialysis catheter is used with patients who have treatment on a dialysis machine. The dialysis catheter separates into two lines. One is for the blood to flow out of your body and through the dialysis machine. The other line is to return your blood to your body once it has been cleaned in the dialysis machine. Jugular vein Subclavian vein Clavicle Under skin Connector Attached clamps Dialysis catheters (and fistulas and grafts) are sometimes called vascular access. page 3 of 12
Tunnelled dialysis catheters are often used when: A patient needs dialysis urgently but doesn't have a fistula or a graft to use. A patient will probably need dialysis for more than two weeks. We have other leaflets that explain about the other types of vascular access. Please ask for them if you would like to find out more. What does the dialysis catheter look like? The catheter is put into a large vein in your chest but a portion stays outside your body. This is where you will see the tube separated into these two lines. Each of these lines has a clamp on it and a bung on the end. The clamp and bung protect the lines, stopping infection and air from going into them when they are not being used. Is the dialysis catheter permanent? No, not usually. Your doctor may decide that a long-term type of vascular access (a fistula) is needed. In this case, the tunnelled dialysis catheter will be removed when the fistula is ready to be used. There are occasions when a doctor will not be able to make a fistula due to the condition of your veins. In this case, the catheter will be used for long-term vascular access. Do I really need to have this catheter? Without the catheter (or a fistula or a graft) you will be unable to have treatment on the dialysis machine. In this case you will become unwell and eventually die. page 4 of 12
How is the catheter put in my body? A doctor will put your dialysis catheter in place. This is done under local anaesthetic and so you will be awake through the procedure. While you are having the catheter put in you may have your blood pressure and blood oxygen levels measured and your heart monitored (an ECG). To put the catheter in place, the doctor will make a small opening under your skin. This is called the insertion or entrance site. One end of the catheter is put through this opening and into a large vein in your chest. The other end of the catheter comes out of the body through a second small opening just below the insertion site. This is called the exit site. At first, the catheter is held in place with stitches. Your nurse usually removes the stitches eight weeks after the operation and when the skin around the catheter has healed and is holding it in place. A nurse will put a dressing over the exit site, which must stay on at all times. Most catheters are put in with the help of an x-ray machine to guide the catheter to the right place. If the x-ray machine hasn't been used when the catheter is put in we will take you for a chest x-ray afterwards. This is to check that the catheter is in the right position. The catheter can be used for dialysis treatment once the x-ray has been checked by a doctor. page 5 of 12
Can anything go wrong when I have my dialysis catheter put in? Yes, as with any procedure, there are things that can go wrong. In about 3 in 1,000 cases there will be bleeding from the exit site. It is always possible to stop the bleeding. But if you notice blood on the dressing please tell a nurse. In about 6 in 1,000 cases a hole is made in the artery instead of the vein. This can cause a bruise to develop. The doctor is usually aware straight away when this happens and will press on the skin to stop the bruising. Rarely (in less than 1 in 2,000 cases), air or blood enters the lung when the line is put in. If this happens you will notice shortness of breath and some discomfort in the chest area. If this happens to you tell the doctor or nurse straight away as the problem will need treatment if it is not to become dangerous to you. In about 10 in 1,000 cases the catheter is not in the right place and so needs to be moved. The catheter not working even though it is in the right position. Getting an infection. Dialysis catheters carry a much higher risk of developing an infection than if you have a fistula or graft. This risk will be reduced if you follow the advice on looking after your catheter at home. What happens after the catheter is put in? If you have had the catheter put in as an outpatient you need to stay in the x-ray department for about 30 minutes before you can leave. If you need dialysis after the catheter is put in you will be allowed home after your treatment is finished. The nurse will give you some dressings to use if the one covering your exit site needs changing. page 6 of 12
If you have had the catheter put in while you are an inpatient you will be able to go back to the ward after the procedure. How might having a catheter affect my life? Most patients find that the catheter interferes very little with their life. It should not stop you doing anything you want to, except swimming, as this carries a high risk of infection. You can bath or shower although showering is better. If you do have a bath, make sure that the catheter and exit site do not go under water as this could lead to you getting an infection. Having a dialysis catheter will not prevent you from travelling. But some dialysis centres will not take holiday patients with catheters. If you wish to travel on holiday, please discuss your plans with your nurse before making any arrangements. We have another leaflet that tells you about having dialysis when you go on holiday. Please ask us if you would like to read it. Do I need to do anything to look after my catheter when I am at home? You do not have to clean the catheter exit site yourself; your nurse will do this when you come for dialysis treatment. But you should do your best to stop the exit site getting wet and dirty. Do not replace the dressing unless it gets wet, very dirty or it falls off. If this happens, wash and dry your hands, gently dry the exit site with a clean unused towel and put on a new dressing. Never use any cream or powder around the line or exit site unless you have been given them by staff at the renal unit. page 7 of 12
Can anything go wrong with the catheter when I am at home? Rarely problems can happen with the catheter such as: Bleeding from the exit site Signs of infection develop (such as a high temperature or a red or oozing exit site) A split or break in the catheter or the bungs fall off More of the catheter seems to be outside the body The catheter falls out If any of these happen, telephone the renal unit straight away for advice. We explain how to do this at the end of this leaflet. You may need to come to the renal unit for treatment. Will the catheter ever need replacing? Occasionally the catheter will need to be replaced. Your doctor will explain why this needs to be done. It may be because the catheter has been damaged or is not working well when you have your dialysis. page 8 of 12
Tips for looking after your dialysis catheter You should have no problems with your catheter if you remember the following tips: 1. Protect the catheter: a. from being accidentally pulled out b. from being damaged c. by not using or allowing someone else to use, sharp objects like scissors or safety pins near the catheter 2. Never open the clamps. The clamps protect you and the line from infection and from air entering your body. Opening them could be very dangerous indeed. 3. Make sure the bungs remain in place at all times. Like the clamps the bungs help stop infection and air getting into the catheter so do not remove them. 4. Always wash your hands before touching your catheter or exit site. The risk of infection (such as MRSA) with this type of catheter is higher than other types of vascular access so care needs to be taken when handling it. 5. Do not allow a doctor or nurse to touch your catheter unless they have washed their hands first and are wearing gloves. They should only handle the ends of the lines using sterile gauze. 6. Your catheter should not be used to take blood or give drugs. This is something that should only be done in an emergency or after discussion with a renal doctor or nurse. page 9 of 12
Contact details If you have any questions or concerns about your dialysis catheter and you are already having dialysis, please telephone the unit where you have your treatment. Peter Moorhead Dialysis Unit Sunday - Friday 7.00am - 9.00pm 0114 271 5136 or 0114 271 5158 Renal G Floor Monday - Saturday 7.00am - 9.00pm 0114 226 9481 Barnsley Dialysis Unit Monday - Saturday 7.00am - 9.00pm 01226 434 910 Chesterfield Dialysis Unit Monday - Saturday 7.00am - 9.00pm 01246 512 626 Rotherham Dialysis Unit Monday, Wednesday and Friday 7.00am - 9.00pm Tuesday, Thursday and Saturday 7.00am - 12 midday 01709 838 333 Sheffield Dialysis Centre Monday, Wednesday and Friday 7.00am - 9.00pm Sunday, Tuesday and Thursday 7.00am - 6.00pm 0114 229 0970 page 10 of 12
If you are not having dialysis yet or your dialysis unit is closed, please call: Sorby renal outpatients (Room 1) Monday - Friday 8.30am - 4.30pm 0114 271 5320 Any other time telephone: Renal Ward (Northern General Hospital) 0114 226 6391 or 0114 271 5408 page 11 of 12
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