Tunneled dialysis catheters

A tunneled dialysis catheter is a soft, flexible tube used for hemodialysis. It enters the large vein at the base of your neck, called the internal jugular vein, and its tip rests where the large vein meets the heart. The outer part travels a few inches under the skin, the tunnel, and comes out on your upper chest below the collarbone.

Outside the skin, the catheter splits into two color-coded ends. One takes blood to the dialysis machine and the other returns clean blood. Under the skin sits a small fabric cuff. Over 2–3 weeks your tissue grows into the cuff, which anchors the catheter and forms a barrier against germs.

What we see

You may need a tunneled catheter if you need to start hemodialysis soon and do not yet have a working fistula or graft, if your fistula or graft has failed and cannot be fixed right away, or if you are waiting to start peritoneal dialysis or receive a kidney transplant. Common causes of kidney failure include diabetes, high blood pressure, kidney inflammation (glomerulonephritis) and polycystic kidney disease.

For these reasons, guidelines recommend a catheter as a bridge. Ask your kidney team about a plan for a fistula, graft or peritoneal dialysis early, so the catheter can come out as soon as possible. For a side-by-side look at the options, see understanding your dialysis access.

The procedure is done at El Camino Hospital in the interventional radiology suite. A nurse, a radiology technologist and your interventional radiologist are with you, and your heart rate, blood pressure and oxygen are monitored throughout. Most catheters go on the right side, because that path to the heart is straightest.

1. 1
   Relax and numb

   You receive moderate sedation through your IV, so you are drowsy and comfortable. We clean the neck and chest and numb the skin with local anesthetic.

2. 2
   Enter the vein with ultrasound

   Using ultrasound, we place a small needle into the jugular vein in the lower neck and pass a thin guidewire toward the heart, watching on X-ray.

3. 3
   Tunnel and place the catheter

   We make a small nick on the upper chest and create a short tunnel under the skin up to the neck. The catheter is pulled through the tunnel and slid into the vein until its tip sits at the entrance to the heart. You may feel pressure, but not sharp pain.

4. 4
   Check and secure

   An X-ray confirms the tip position and we test the flow. The neck nick is closed with glue, the catheter is held with a stitch at the chest, and a sterile dressing is applied.

Placement usually takes about 20–30 minutes. The catheter is filled with a small amount of blood-thinning solution, called a lock, to keep it from clotting between sessions.

You rest in recovery for about 30–60 minutes and can eat and drink. Take it easy for the rest of the day, and do not drive, drink alcohol or make important decisions until the next day. Mild soreness in the neck and chest is normal for 2–3 days; acetaminophen (Tylenol) is the safest pain reliever. Avoid heavy lifting and strenuous activity for about a week.

The catheter can be used for dialysis right away. It sometimes runs a little slowly in the first one or two sessions and then improves. Only your dialysis team should open, flush or use your dialysis catheter; it is not meant for IV medicines or blood draws outside dialysis.

A catheter infection can spread into the blood quickly, so do not wait for your next session if you have fever or chills. Treatment is antibiotics, and sometimes the catheter needs to be exchanged or removed.

When your fistula, graft or peritoneal dialysis is working reliably, call us at 650-404-8445 to schedule removal. Leaving an unused catheter in place only adds infection and vein risk.

Removal is a short procedure, usually done with local numbing only. We free the fabric cuff from the tissue under the skin and slide the catheter out, then press on the neck for several minutes. It takes about 5–15 minutes. Keep the small dressing dry for 24–48 hours, and call if you see bleeding, swelling or signs of infection.