Tunnelled haemodialysis catheter

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1 Liver, Renal & Surgery Tunnelled haemodialysis catheter Information for patients and carers This leaflet explains what a tunnelled haemodialysis catheter is and how it is put in. It also covers the risks of the procedure and how to look after your catheter. 1

2 What is a tunnelled haemodialysis catheter? It is a soft, bendy tube that allows you to be given dialysis. We put it into one of the large veins (not an artery), either in your neck or rarely your groin (in the femoral vein). One end runs (or tunnels ) a little way under your skin before it comes out at what is known as an exit site (see picture on page 6). It is held in place by a cuff which sits just under your skin near the exit site. The catheter can then be connected to the haemodialysis machine to allow you to dialyse. A tunnelled catheter is also called a cuffed catheter, HaemoCath, Permcath or Tesio Line. It can stay in position for several months so you can have dialysis as an outpatient. Why do I need a tunnelled haemodialysis catheter? It allows you to be given dialysis: while you are waiting for your fistula (AVF) to form because you have a condition that means you cannot have a fistula. What are the benefits? Compared with a non-tunnelled catheter, a tunnelled catheter: enables you to have dialysis as an outpatient because it is held in place by the cuff and so it is not likely to fall out is less likely to get infected because it tunnels under your skin. But this type of catheter is only temporary until you have a fistula that is ready to be used. A fistula is better than a tunnelled catheter because it reduces your long-term risk of infection and other problems that you can have with haemodialysis catheters. 2

3 What are the risks? This is a low-risk procedure. The most common side effects are: Bruising or pain where the catheter is put in: This usually settles over a few days. You can take standard painkillers such as paracetamol. Bleeding from the exit site: You may have some slight oozing from the exit and/or insertion sites. This should stop within 24 hours. Infection: Although you have the catheter put in under sterile conditions, there is still a risk of infection. This may be at the exit site or in your bloodstream. If this happens, we will give you antibiotics. Sometimes it means we may need to take your catheter out. You can reduce your risk of infection by looking after your catheter very carefully. We explain how to do this on page 8. Rare problems include: Catheter falling out: Although you have your stitches taken out 7 10 days after the procedure, it usually takes up to two weeks before the cuff can adequately hold the catheter in place. During this time it is important that you do not pull or catch the catheter on clothing because it may get pulled out. Catheter in wrong place or bent: Sometimes the catheter may not be in the right position or it may be kinked or bent. We will need to adjust it to improve the blood flow and this may be done in the x-ray department. Arterial puncture: One of your arteries may be pierced by accident during the procedure. The bleeding is usually stopped by putting pressure on the site. Irregular heart rhythm: During the procedure you may develop an irregular heartbeat. We can treat this easily by changing the position of your catheter. You will be attached to a heart monitor during the procedure so we can watch your heart rhythm. Pneumothorax: In very rare cases your lung may be accidentally punctured during the procedure, allowing air to leak into your 3

4 chest. You will have a chest x-ray after the catheter has been put in to check this has not happened. Are there any alternatives? If you are having haemodialysis as an outpatient, you need either a functioning fistula or a tunnelled haemodialysis catheter. There are no other alternatives. Consent We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of the treatment proposed, please do not hesitate to speak with a senior member of staff again. Do I need to prepare for the procedure? You can eat and drink normally before the procedure. Please tell us if you are on anticoagulants (blood-thinning medications) such as warfarin. You may need to stop taking them before the procedure. We will tell you when to stop taking them and for how long. If you are on either aspirin or clopidrogrel you do not need to stop taking the medication. If you are on both aspirin and clopidrogrel, you need to stop taking one of these medications before the procedure. We will tell you which to stop taking and for how long. 4

5 Octenisan Washing prior to line insertion Please wash with Octenisan Lotion the day before your line is due to be inserted. You will receive a bottle from whoever has organised your line insertion. Octenisan is a medicated wash lotion for hair and body to prevent infections including MRSA. It is important to use the body wash as follows; If you shower - Wet the skin and turn shower off. Apply Octenisan to the whole body paying particular attention to the areas around the nose, armpits and groin. Leave on body for about 3 minutes then turn the shower on and rinse off. If you bath - Stand out of the bath & apply Octenisan to the whole body. Leave it for 3 minutes than get in the bath and rinse off. Do not add Octenisan to the bath water as this will dilute it and make it ineffective. What happens before the procedure? You will have some blood tests before your catheter is put in. We may give you a drug called DDAVP to reduce your risk of bleeding. You have this intravenously, which means the medication is injected into a vein in your arm. If you are having the catheter put into your groin, in the femoral vein, you have a higher risk of developing blood clots. So you may need to start taking an anticoagulant (blood-thinning medication) such as warfarin after the procedure. We will discuss this with you if this is the case. 5

6 Will I have a sedative or an anaesthetic? Very few people need sedation or a general anaesthetic. If you do, you will not be able to drive for 12 hours after the procedure and may need to stay in hospital for the night. You must not drink alcohol for at least eight hours after having sedation. Please bring an overnight bag with you and be prepared to stay in hospital in case there is a problem with the procedure. What happens during the procedure? You will have the procedure in a special, sterile procedures room. A doctor will put the catheter in using an ultrasound to guide them. CUFF INSERTION SITE EXIT SITE HEART 6

7 They make a small cut in your neck (or groin), just above your collarbone. This is called the insertion site. They put the catheter into a vein through this cut. The catheter then tunnels under and out through your skin at the exit site. They stitch up the insertion site so the tube can be seen only at the exit site. They put in two more stitches to hold the catheter in place at the exit site. The stitches can be taken out after 7 10 days by your dialysis nurse at your dialysis unit. You will be given a local anaesthetic for the procedure. This means you will be awake during the procedure and can talk to the doctor. Although you may feel some pressure and movement as the catheter is put in, you should not feel any pain. During the procedure you will be linked to a heart monitor to check for any irregular heart rhythm (see page 3). A dressing will be put over the insertion and exit sites to protect them and to reduce the risk of infection. If the catheter is put in your neck vein, you will need a chest x-ray to make sure it is in the right position. How long does it take? A simple procedure takes about minutes. 7

8 What should I do if I have a problem with my catheter? The catheter falls out Your catheter is very unlikely to fall out. If it does, you may have bleeding from the exit site. Press on the insertion site (see picture on page 6) at your neck (not the exit site) for several minutes and contact your dialysis unit or King s Renal Unit straight away. The catheter breaks Your catheter is very unlikely to crack or break. If it does, clamp, pinch or tie something around your catheter just above the break. Contact your dialysis unit or King s Renal Unit as soon as possible. You will have to come back to have it repaired or replaced. Other problems Contact your dialysis unit or King s Renal Unit if you have any of the following symptoms: An above-normal temperature (more than 37 C), fever, chills or feeling generally unwell. Pain, redness or swelling around the exit site. Oozing from around your catheter for more than 24 hours. Cracks or leaks in your catheter. Pain, swelling or discomfort in your neck or arm. How do I care for my catheter? Changing dressings Your dialysis nurse will check your exit site and dressing for signs of infection every time you come in for dialysis. To prevent infection, keep the dressing as clean as possible and follow your dialysis nurse s advice about how to put on a new one. Sometimes dressings can cause itching at the exit site, so we may give you a different type. 8

9 Touching your catheter Try not to touch your catheter and do not let anybody else (including non-dialysis medical staff) use it for anything else other than dialysis. Personal hygiene If you still have stitches in the exit site, keep the site dry and do not shower. You may need to wash at the sink or from a bowl for a while. Once the stitches have been taken out, usually after 7 10 days, you can have a shower. But make sure that the exit site is covered and stays dry. You need to put a new and dry sterile dressing on the exit site afterwards. If the dressing ever gets wet, wash your hands and replace it. You can get new sterile dressings from your dialysis unit. Always wash your hands well before putting on a new dressing. Only use the hand lotion that has been recommended. Discomfort If the ends of your catheter are uncomfortable or keep rubbing against your chest, ask your dialysis nurse to wrap them in sterile gauze after each dialysis session. Having a bath and swimming Do not have a bath or swim. Putting your catheter and exit site under water increases the risk of infection. Playing sports You can do sports that involve low to moderate effort after two weeks. Please talk to your nurse or doctor before doing contact sports or any exercise that involves a lot of effort. 9

10 Who can I contact with queries and concerns? If you have any questions, please contact your local dialysis unit or King s College Hospital Renal Unit. King s College Hospital Access Nurse Specialist: Main Haemodialysis Unit: Fisk Ward: Dialysis units Bromley Unit: Dartford Unit (Darent Valley Hospital): Dulwich Unit: Dulwich Mobile Unit: Sydenham Unit: Woolwich Unit (Queen Elizabeth Hospital): Out of hours Call King s College Hospital on and ask for the Renal Registrar on call. Sharing your information We have teamed up with Guy s and St Thomas Hospitals in a partnership known as King s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy s or St Thomas. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals. 10

11 Care provided by students King s is a teaching hospital where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road - staff will be happy to direct you. Tel: Textphone: Fax: If you would like the information in this leaflet in a different language or format, please contact PALS on

12 Corporate Comms: 0627 PL602.1 July 2013 Review date July 2016

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