Patient education: Hemodialysis catheter placement (The Basics)

What is hemodialysis? — Hemodialysis is a treatment for kidney failure. Normally, the kidneys filter blood and remove waste and excess salt and water. Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.

With hemodialysis, a machine takes over the job of the kidneys. Blood is pumped from the body, filtered through a dialysis machine, and then returned to the body.

What is a hemodialysis catheter? — To have hemodialysis, you need a way for blood to leave and return to your body. This is called an "access." A hemodialysis catheter is 1 type of access. This type of catheter is also called a central venous catheter or "CVC." It is a thin tube that goes into a large vein, usually in the neck (figure 1).

A hemodialysis catheter can go directly into the vein or might be "tunneled" under the skin. Catheters that go directly into the skin are used only when hemodialysis is needed right away. If hemodialysis is needed for a longer time, a tunneled hemodialysis catheter is used. Tunneled hemodialysis catheters will have 2 ends called "lumens" or "hubs." These stay outside of the body and are covered with caps when not in use. Most hemodialysis catheters have a clamp that closes off the lumens.

You might get a non-tunneled hemodialysis catheter temporarily, until your doctor can create another type of access called an "AV fistula" or "AV graft." Or you might keep a tunneled hemodialysis catheter in place.

How do I prepare for hemodialysis catheter placement? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get some lab tests.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, past central lines, and any medicines you take. Tell them about:

●Any central lines you've had in the past – This is important no matter how long ago you had them or where they were located.

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during the procedure? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure.

●The doctor will clean your skin with a special soap. They will cover your body with sterile towels and sheets. They will wear face masks, hats, gowns, and gloves to help prevent infection.

●Catheters for long-term hemodialysis are placed through the skin and into a blood vessel, and are "tunneled" under the skin. For a tunneled hemodialysis catheter:

•The doctor will make a small cut near the planned "insertion site." Another small cut is made lower on your chest. This is the "exit site." The doctor will make a small tunnel under your skin between the 2 cuts.

•The catheter is pulled through the tunnel, and the end with the lumens is stitched to the exit site.

●The doctor will use ultrasound to find the best vein. They will use fluoroscopy (a continuous type of X-ray) to guide the catheter into a large vein near your heart.

●When the procedure is done, the doctor or nurse will "flush" the catheter with a sterile fluid. Then, they will place a cap on each of the lumens.

●In some cases, the doctor or nurse will put a small sponge disc where the catheter goes into the skin. This can help prevent infection. They might also use a special device to help hold the catheter in place. They will place a special bandage over your catheter to keep it from moving and to keep it clean.

●The procedure usually takes less than an hour.

What happens after the catheter is placed? — After they are finished, the doctor or nurse will do an X-ray. This is to make sure that the tip of the catheter is in the right place before it is used. If you are in the hospital, having a hemodialysis catheter will not make your stay longer.

The staff can use your catheter for dialysis right away after it is placed.

What are the risks of a hemodialysis catheter? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Blood clot

●Bleeding

●The catheter stops working, breaks, or leaks

●The tip of the catheter moves out of place

●Collapsed lung (called "pneumothorax")

●Injury to a blood vessel

●Abnormal heartbeat

●Problem with blood flow during dialysis

What else do I need to know? — If you are going home with a hemodialysis catheter, you might need a family member or friend to help you care for it. Some people have a home health nurse come to their home to help with this.

More on this topic

Patient education: Hemodialysis (The Basics)
Patient education: Preparing for hemodialysis (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Choosing between dialysis and kidney transplant (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Low-potassium diet (The Basics)
Patient education: Acute kidney injury (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Kidney transplant (The Basics)
Patient education: Planning for a kidney transplant (The Basics)
Patient education: Arteriovenous vascular access for hemodialysis (The Basics)

Patient education: Hemodialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)
Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Low-potassium diet (Beyond the Basics)