Tunneled Dialysis Catheter Insertion Patient Education

Pre-Procedure Patient Information

What is a Tunneled Dialysis Catheter Insertion?

Tunneled dialysis catheter insertion is a procedure to place a long, thin, plastic tube (catheter) into a vein in the neck and move it to a larger central vein near the heart. During the procedure, the catheter is tunneled under the skin. This means that the catheter is inserted under the skin and then moved away from the insertion site. Placing the catheter a few inches away from the insertion site reduces the risk for infection.

You may have this procedure if you have severe kidney disease and need treatment to filter your blood and remove extra fluid from your body (hemodialysis).

What conditions should I make sure my doctor is aware of?

Before your exam, you should notify the doctor or nurse of:

  • Any drug/food allergies
  • Allergies to IV contrast
  • Any blood thinning medications (anticoagulants) that you are taking
  • Any medical conditions you have
  • If you have an active infection
  • Whether you are pregnant or may be pregnant
  • Any problems you or your family members have had with anesthetic medications

What are the risks?

Generally, this is a safe procedure. However, as with any procedure, complications can occur. Possible complications include:

  • Infection
  • Bleeding
  • Allergic reactions to medicines or dyes
  • Damage to other structures or organs in the neck or chest
  • A blood clot that forms in the neck and travels to the heart
  • A blood clot that blocks the catheter
  • Catheter failure
  • A collapsed lung (pneumothorax)

About the Procedure

Before the procedure:

  • Your health care provider may want you to have blood tests. These tests can help tell how well your kidneys and liver are working. They can also show how well your blood clots.
  • Do not eat or drink within eight hours of your appointment.
  • If you have diabetes and use insulin, you may need to adjust the dosage of insulin the day of the procedure. Your primary care doctor can help you with this adjustment.
  • If you are on blood thinning medications, you may need to stop them prior to the procedure. Check with your primary care doctor about when it is safe to stop blood-thinning medicine.
  • Do not discontinue any medication without first consulting with your primary care or referring physician.
  • Do not take new dietary supplements or medicines during the week before your procedure unless your health care provider approves them.
  • Plan to have someone take you home and stay with you for the first 24 hours after you leave the hospital. You should not drive or operate heavy machinery for at least 24 hours after the procedure.

The day of the procedure:

  • Make sure you shower on the day of your procedure, washing the anticipated insertion site with soap and water.
  • If you are told to take a medication or to continue taking a medication on the day of the procedure, take the medication with a small sip of water.
  • Please arrive and register at admissions in the lobby of the hospital at your scheduled time.
  • You will be escorted to the prep area, where you will be connected to a blood pressure machine that will take your blood pressure and your heart rate. You will also have electrocardiogram (ECG) leads placed on your chest to allow us to monitor your heart during the procedure.
  • A nurse will insert an IV into your arm. During the procedure, this IV may be used to give you medications. These medications may include medicine to help you relax and reduce pain. The nurse will also review your medical history and medications, listen to your heart and lungs and make sure you have followed all your pre-procedure instructions.
  • Your physician will obtain your consent for the procedure. The physician will explain the procedure including possible complications and side effects. They will also answer any questions you may have.

During the procedure:

You will be awake during the procedure. You will be positioned on your back for the procedure. Let the staff know if the position is not comfortable. The access site for the catheter will be cleansed with a special antiseptic solution. Sterile drapes will be placed. The doctor will inject a small amount of local anesthetic through a very small needle in the skin where the catheter will be inserted. It feels like a pinch and then a slight burning as the local anesthetic starts numbing the skin. Two incisions will be made at your insertion site. Usually, the incisions are a few inches away from each other. A tunnel will be made under your skin, between your two incisions.

A needle will be used to access the vein. Imaging (US) can be used to guide the needle into the vein. A small amount of dye may be injected through the needle. An X-ray can then be taken to make sure that the needle is in the correct place. Using a wire, the needle will be removed and a catheter will be placed in the vein and threaded through the tunnel under your skin. Your provider may use X-ray equipment to watch the catheter being inserted. This allows your provider to watch the catheter on a live display while guiding it into place. The catheter will be guided into the central vein near your heart. The cuff of the catheter will remain in the tunnel under your skin. The cuff helps to keep the catheter in place.

Stitches (sutures) will be used to partially close your incision and to hold your catheter in place where it exits your body. An X-ray may be done to make sure your catheter is in the right place. Caps will be screwed onto the ends of the catheter that are outside of your body. The incision that was used to insert your catheter may be closed with sutures, skin glue, or adhesive strips. Hand pressure may be held on the access site for a period of time. Your skin will be cleansed, and a bandage will be applied.

After the procedure:

  • You will stay in the recovery area for observation for 1-2 hours.
  • The insertion site will be checked frequently.
  • You will be asked about your pain.
  • The nurses will review your discharge instructions with you.
  • You will then be discharged home. Someone must drive you home and stay with you for 24 hours.

Can I resume normal activities?

  • Do not drive or operate heavy machinery for 24 hours after the procedure.
  • Resume your normal diet.
  • Return to your normal activities when your health care provider says that it is safe.
  • Keep your dressings clean and dry. The dressing will be changed at dialysis.
  • Leave the caps on the ends of the catheter when not in use.
  • Do not pull on your catheter.

What do I do for follow up visits?

Please make a follow up appointment with your ordering physician for follow up care.

Contact Information:

Contact your ordering physician for any questions or concerns to include:

  • Catheter site problems to include:
    • Redness, swelling or pain
    • Fluid or small amount of blood
    • Puss or a bad smell
    • Not working properly
    • Fluid is leaking from the catheter, under the dressing, or around the dressing
  • You have a fever that does not get better with medicine
  • You feel like you may vomit or you vomit
  • Your skin becomes itchy or you develop a rash or hives

Get help right away if:

  • You have very bad bleeding from the catheter or insertion site
  • Your catheter develops a hole or it breaks
  • Your catheter comes loose or gets pulled completely out. If this happens, press on your catheter site firmly with a clean cloth until you can get medical help.
  • You have swelling in your shoulder, neck, chest, or face
  • You have chest pain
  • You are short of breath or have trouble breathing
  • You feel dizzy or you faint

These symptoms may be an emergency. Get help right away. Call 911.

  • Do not wait to see if the symptoms will go away.
  • Do not drive yourself to the hospital.