A dialysis catheter, also called a dialysis line, is one way to reach the blood for haemodialysis. This guide explains what it is, how it is inserted, how to look after it and which problems to report. It does not replace the advice of your own doctor or dialysis nurse.
What is a dialysis catheter?
A dialysis catheter is a soft tube that is passed into the body to enter a blood vessel and stay there. One end remains inside the blood system. The other end stays outside the body and is connected to the dialysis machine. Blood is drawn through the tube into the machine, cleaned, and returned.
Types of dialysis catheter
- Acute (temporary) line: needed urgently and passed quickly. It lasts only a few weeks
- Tunnelled line: takes a little longer to place and is designed to last longer, usually months
Where is it placed?
Dialysis catheters can be placed in four sites: the right side of the neck or upper chest, the left side of the neck or upper chest, the right groin and the left groin. A catheter in the neck or upper chest reaches close to the heart. A catheter in the groin does not.
How is it inserted?
The procedure is done while you are awake and takes about an hour. In outline:
- You lie down
- The skin is cleaned with an antiseptic solution that kills germs
- You are covered with sterile drapes, leaving only the area to be worked on
- An injection numbs the area, so you do not feel pain
- A special needle is passed through the numbed area into the blood vessel, and a thin wire is passed through the needle
- The needle is removed, leaving the wire in place, and the catheter is passed over the wire into the vessel
- The wire is removed, leaving the catheter in the blood vessel
- The catheter is stitched to the skin so that it stays in place
- It is flushed with a special solution to stop it clotting, and then covered with a dressing
Why a catheter is not a long-term solution
A dialysis catheter is a tube, and it is not natural to the body, so problems tend to appear the longer it stays. A catheter may work for a couple of months and usually does not last a year. By comparison, an AV fistula can last several years if it is looked after well. That is why catheters are mainly used when dialysis is needed urgently, or while a fistula or graft is being made.
Looking after your dialysis catheter
- The dressing is changed by the dialysis staff each time you have dialysis. The old dressing is removed, the catheter and the skin around it are cleaned with antiseptic, and a new dressing is applied. This is the main protection against infection
- The catheter must always be covered. Keep every part of it hidden under the dressing, and do not tie it up with a scarf or cloth
- Keep the dressing dry and neat
- Only dialysis staff, wearing gloves, should handle the catheter. Do not touch it yourself or let anyone else touch it
- Use it only for dialysis. It should not be used for drips, medicines or blood samples outside the dialysis session
- The catheter is flushed with a special solution after each use, which stops it from clotting
- Avoid tight clothing over the catheter, because it can be pulled out when you undress
Possible problems
- Bleeding around the catheter: if it happens on the day of insertion or the next day, it is usually because the opening in the skin is slightly larger than the tube. A new stitch can narrow it
- Infection: germs can enter where the catheter passes through the skin, or at the outer end where it is connected and handled. Signs include fever, chills and shaking, especially during dialysis, and pus around the catheter where it enters the skin. The catheter usually has to be removed, antibiotics given and a new one placed at a different site
- Blockage: a clot can form inside the catheter, so that blood does not draw freely. This is prevented by flushing after each use. A blocked catheter may need to be replaced at a different site
- Breakage: the catheter is soft and flexible for comfort, which is also why it can break. Handle it gently. A broken catheter has to be replaced
- Falling out: sometimes the whole catheter comes out. It then has to be replaced at a new site, so please protect it well
When to get help at once
- Fever, chills or shaking
- Redness, pain or pus around the catheter
- Bleeding around the catheter that does not stop
- The dressing is wet, dirty or coming off
- The catheter is damaged, has moved or has come out
If the catheter has come out and bleeds heavily, press firmly on the area and go to the nearest hospital or clinic immediately.
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This article gives general information and does not replace advice from a doctor. To discuss your own situation, please book a consultation.