Hemodialysis Access

Dialysis/pheresis catheters are used to “clean” the blood in patients with kidney failure requiring hemodialysis or patients with immune diseases requiring plasma pheresis. These treatments require rapid flow of blood in and out of the body and thus the catheters tend to be relatively large in diameter (approximately 4mm)


Specific catheters:
AshSplit® catheter -- tunneled catheter
Hemoglide catheter -- tunneled catheter
 
Quinton® catheter (for short-term use) –non-tunneled catheter.

The catheter chosen for you depends on its intended use and the expected length of time it will be needed.

These catheters are usually placed into a vein in your neck (internal jugular) or sometimes under the collar bone (subclavian).  They are referred to as “tunneled catheters” because part of the catheter travels under the skin. This actually reduces the risk of infection and is makes it more convenient to manage them.


What happens during the procedure?

Conscious sedation is provided just prior to starting the procedure. You will be connected to several types of monitoring equipment. 


You will be lying flat on the x-ray table. Pillows can be placed under your knees to help take the pressure off your back. A towel is wrapped around your head to protect your hair from the antiseptic solutions used to clean your skin. Sterile drapes are placed over your head and body with your neck/upper chest exposed. Your face will not be covered and the nurse can communicate with you during the procedure.


Lidocaine local anesthesia will be injected under the skin overlying the site of entry into the vein.  You will have sensations of pushing or pulling but you should not feel sharp pain during the procedure. After the catheter is tunneled under your skin, you will have an x-ray to ensure the tip of the catheter is positioned within or near the right atrium of the heart.


Finally the catheter is sutured to the skin. Over the ensuing weeks your body will form a tight seal around the “cuff” of the catheter and the sutures will no longer be necessary. The sutures should stay in for at least 2 weeks following the placement of the catheter. This seal also is important in guarding against infection.  Your dialysis nurse will remove the sutures when the time comes.


This procedure takes approx 1hr- 1.5hrs


What happens after the procedure?

If conscious sedation medicine was administered, you will be required to stay to recover for 2 hours following the end of the procedure. After the initial dressing is applied, the dialysis nurse will take care of changing the dressings. You will be given a discharge instruction sheet for when you go home. You must have a responsible adult available to drive/escort you home from the hospital.

Caring for your Catheter at home:

·         Keep catheter site clean and dry.

·         Tell your doctor and dialysis nurse if you have any pain, redness, or swelling at the exit site or the catheter.

-          DO NOT pinch, poke, bend, or pull at your catheter.

-          DO NOT use sharp objects around your catheter.

-          DO NOT get your catheter wet.  (Cover catheter site with saran wrap / foil to shower).

·         Always keep your catheter secured to your skin to prevent accidentally pulling it out.

What to watch for:

Infection signs:

     Fever, chills, redness or tenderness and /or swelling and drainage from the exit site.  You may feel tired, have nausea or vomiting, if any of these occur, call your doctor.

Bleeding:

     If there is blood leaking from your catheter:  Pinch, clamp, or tie off end of catheter.  If bleeding around catheter exit site, put direct pressure where catheter enters neck and vein.  Call your doctor immediately.

Clotted Catheter:

     No blood return when nurse tries to start dialysis, catheter will need to be declotted or changed.

Pneumothorax:  (Air in lung)

     Shortness of breath or chest discomfort within hours of catheter insertion. 

THIS IS AN EMERGENCY!  CALL 911.

Air in Catheter: 

      May occur if the catheter is cut or cap is removed accidentally.  You may experience shortness of breath, chest pain or pass out.  THIS IS AN EMERGENCY! CALL 911, then lie on your left side with your head down and feet elevated until help arrives.

Swelling of the Neck, Arm, or Hand on catheter side:

If this occurs, call your doctor, he may want to get a special x-ray.

 

If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.

This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.