Tunneled Hemodialysis Catheter Procedure

When your kidneys functions collapse and you are unable to purify your blood or eliminate excess fluid from your body, hemodialysis is a procedure performed. Your blood can be obtained for hemodialysis either a vascular access or hemodialysis access.

The following options are available to you if you get hemodialysis:

an arm vein and artery joined together to form an AV fistula

An AV graft that joins an arm vein and artery via a flexible tubing

Normally in your neck, a catheter is a soft tube that is inserted into a big vein.

The best option for your access should be a fistula because it often lasts longer and has less issues like infections and clotting. Some individuals, however, might not be eligible for a fistula because their blood vessels are too weak. Grafts are considered as the backup option for an access. Catheters are often used for short-term access, although they can also be permanent. You might be able to change from another sort of accessibility to a fistula sometimes.

What exactly is a hemodialysis catheter?

Hemodialysis catheters are tunneled catheters because they are inserted under the skin. Cuffed and uncuffed tunneled catheters are the two options. Non-cuffed tunneled catheters are utilized in urgent situations and for brief durations of time (up to 3 weeks).

What kind of different permacath are there?

Permacath is the term for a tunneled hemodialysis catheter, which typically has two lumens and a polyester cuff that is placed one to two centimeters from the skin exit point, which is typically on the chest. Silicone and other polymers, such as thin polyurethane, are typically utilized in catheter construction because they are less thrombogenic than the components employed in catheters without tunnels. These catheters differ from non-tunneled catheters, also known as Quinton catheters or Vascaths, in that they are blunt, soft, and more flexible.

Types	Duration	Indication	Examples
Non-tunneled: The subcutaneous tissue is not tunneled; instead, the catheter is placed by making a small puncture in the skin and vein.	Short duration – Few days to about three weeks	Challenging intravenous access Administering irritating drugs Inotropes and vasopressors Total parenteral nourishment for a limited time	Multi-lumen short-term CVC Percutaneous introducer Hemodialysis catheter used temporarily (Vascath®)
Peripherally placed: A vein in the upper arm is used to place the catheter.	Medium term: a few weeks to a few months or perhaps a year	Challenging intravenous access A blood test administering drugs over the long term (e.g. antibiotics) Administering irritating medications (such as chemotherapy) Complete parenteral alimentation
Tunneling: The process by which the catheter’s proximal end is taken out through the skin at the exit location after being tunneled subcutaneously from the implantation location.	Long-term – from months to years, for irregular or ongoing access	Long-term use of irritating medications (such as chemotherapy)	Hickman’s® Broviac® Permanent hemodialysis catheters – Perm-Cath®, Hemosplit®, or Equistream®)
Completely implantable – A line that is inserted surgically into an organ, cavity, or artery and connected to a reservoir or “port” underneath the skin.	A long time – from months to years, for intermittent or ongoing access	Long-term intermittent accessibility. For instance, individuals who often enter hospitals and have inadequate intravenous access The use of irritating medications, such as chemotherapy	Portacath®

What areas are used to insert catheters?

Central venous catheters can be inserted at three different locations. The ideal regions for temporary central venous catheter implantation are the interior jugular vein, common femoral vein, and subclavian vein. The basilic and brachial veins are also used for peripherally implanted central catheters for mid-term and long-term central venous access (PICCs).

What exactly does a tunneled central line catheter mean?

A thin, flexible tube (catheter) that is tunneled underneath the skin before accessing a big vein is called a tunneled central line. It usually enters the internal jugular vein in the neck and travels down to a bigger vein directly just above the heart (cavoatrial junction). The catheter contains a little cuff that assists to keep it in position and acts as a protection to avoid infection. It is tunneled through the skin a few inches above the nipple border. One, two, or three lumens are possible for the catheter (single, double, triple lumen). It goes by a number of names, such as Hickman, Broviac, Groshong, or TDC (tunneled dialysis catheter).

Where is it situated?

In the interventional radiology unit, the catheter is inserted by a medical professional. An IV will be inserted, and you’ll receive a tranquiliser. Your chest and neck skin are washed with a specific soap before a sterile drape is draped over your entire body. To ease and reduce any pain, a numbing medication will be administered to you. Although there shouldn’t be any discomfort, the catheter placement will nevertheless cause you to experience strain. The right vein is found via ultrasonography. To ensure that the catheter is positioned correctly, X-ray images are acquired during the surgery. During the surgery, two tiny incisions will be created. One at the tunnel departure point, which is often a few inches above your nipple, and one at the insertion site close to your collarbone. The cuts are subsequently stitched, taped, or sealed using a specific material. Your chest will be bandaged and the catheter will be stitched into position.

Why is anyone receiving this treatment?

Patients may require a tunneled central line catheter for a number of reasons. These consist of:

Chemotherapy
Hemodialysis (filtering blood)
Parenteral Nutrition Integrated (TPN)
transfusions of blood
Plasmapheresis (exchanging or removing blood elements)
hydration and drug administration.

Who shouldn’t receive this treatment?

If you experience either of the following, you shouldn’t undergo this procedure:

Serious bacterial infection in your blood
An infection of the skin around the potential site of catheter insertion
A recognised sensitivity to the catheter material
A bleeding condition that cannot be treated
Obstruction of the vein (thrombosis)

Benefits

Since the catheter may be used for many weeks, months, or even years, you can stop getting stuck with needles. Additionally, some drugs can only be administered via this style of catheter. Once your treatment is over, the catheter can be taken out at any time.

Risks

Although there are dangers associated with any medical operations, these risks are quite minimal for this procedure. The following are the procedure’s most frequent risks:

Infection: To lessen this danger, they employ sterile procedures and specific antibacterial soap.
Bleeding: Usually very little and finishes immediately after the operation.
The catheter is ineffective: This may occur if the catheter moves or develops a clot at the tip. To prevent any movement, they tape and stitch the catheter into position. We may additionally use a modest quantity of a blood thinner (Heparin) depending on the kind of catheter to prevent clot forming. As soon as the catheter is in place, we test it to make sure it functions properly.
damage to nearby structures. To locate the ideal point of entrance into the vein and guarantee optimal positioning at the cavoatrial junction, we employ ultrasound and x-ray.

Before the operation, what should I expect?

Should I fast before the procedure?

Yes, you must refrain from eating and drinking for 6 hours prior to the operation.

Should I stop taking any medications?

Yes. Before the surgery, any blood-thinning drugs, such as Coumadin, Lovenox, and Plavix, are often withheld. Based on the type of blood thinner you are taking, you will get instructions. You can keep taking aspirin.

How else could I get ready?

To get ready, bring a listing of all your prescription medications with you. Additionally, you ought to arrange for a ride after the operation.

What to anticipate throughout the methodology?

Treatment time: 30 to 60 minutes

Conscious sedation, meaning you can still communicate with the nurse and doctor in the room but will feel extremely at ease and may not recall every detail of the process.

How is the process carried out?

You will be requested to lay flat on the operation table as soon as you enter the treatment room.
A special soap will be used to clean the skin on your chest and the area around your neck.
To keep the treatment clean, a blue drape will be put beside your head and over your chest.
The jugular vein in your neck will be located by the doctor using ultrasonography.
You’ll then receive some numbing medicine.
For access to the vein, a tiny cut will be performed above your collarbone.
An X-ray will be obtained once venous access has been established to confirm the correct location.
Around the location where the catheter will be tunneled, more numbing medicine will be administered into your chest.
The exit location will then be cut, often a few inches above the nipple.
The catheter will then be inserted through a tube beneath your skin.
The tunneled catheter will then be inserted into your vein while you are instructed to hold your breath.
Continuous X-ray images will be obtained at this period to guarantee optimal positioning.
After the catheter’s location has been confirmed, your chest and neck will be cleansed, and your incisions will be closed with sutures, special tape, and/or adhesive.
The catheter and wounds will then be covered with sterile gauze and transparent tape until they have healed completely.

What to anticipate following the procedure?

Discharge is anticipated to occur up to 4 hours following the treatment.

Postoperative care:

Where the catheter was inserted, you could have some little pain, bruising, and swelling; however, these side effects should subside within a few days.
Unless your physician has prescribed something else, you are allowed to take over-the-counter painkillers like acetaminophen (Tylenol) or ibuprofen (Advil) for mild discomfort.
The catheter region should not be soiled, damp, or submerged in water.
After 24 hours, you can take a shower. To maintain the dressing and catheter dry, the area should be wrapped with plastic wrap and the edges taped down.
In order to give your incisions time to heal, you should also refrain from any vigorous activities for the next three to five days.
Put on a fresh dressing and tape it in place if the old one becomes wet or slips off.
Keep sharp items away from your catheter.
Your doctor or nurse needs to flush your catheter once a month while it’s not being used.
Any unexpected symptoms, such as a fever, chills, soreness, or swelling, should be reported to your doctor.