Central venous haemodialysis catheters

A central venous haemodialysis catheter is a narrow tube that is inserted into one of the veins near the heart and held securely by a cuff under the skin. The tube is usually made up of two narrow tubes joined together, so that blood can be taken out and returned to the body using the same tube.

A central venous haemodialysis catheter can be used to access the blood system immediately after it is inserted so this may be the first access method your child needs. It may also be used as a temporary option while a fistula is forming.

Your child will need to have an operation to insert the catheter. This is carried out under very heavy sedation in older children or general anaesthetic in younger ones and generally takes around one to two hours.

What does the operation to insert it involve?

This may be undertaken by a surgeon or by one of our X-ray doctors (interventional radiologist). The catheter will be inserted into a vein in your child’s neck. This vein leads into the heart.

Ultrasound is used to locate the blood vessel and to guide the insertion of the catheter. It is tunnelled under the skin before being brought out from under the skin. This place is called the exit site.

A short length of tube will be left outside the body so that the blood system can be accessed easily.

Your child will come back to the ward with a dressing on his or her neck and over the tube.

What happens afterwards?

After the operation, your child’s shoulder and neck area may feel sore and bruised. This will settle down in a day or two. In the meantime, your child will be given pain relief to make him or her as comfortable as possible.

Are there any risks?

Every anaesthetic carries a risk of complications but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any complications.

After an anaesthetic, some children feel sick and vomit, have a headache, sore throat or feel dizzy. These effects are usually short lived.

Any surgery carries a small risk of infection or bleeding. As your child will have a direct method of entry into the blood system, he or she is at an increased risk of infection. The exit site can also become infected. However, good care of the exit site and careful access of the catheter can minimise this risk.

Dialysis using a central venous haemodialysis catheter

Only trained nurses connect your child to a dialysis machine. This is because a central venous haemodialysis catheter carries a greater risk of infection and special procedures need to be followed.

When dialysis finishes, the catheter is filled with a solution called heparin that stops the line clotting with blood between dialysis sessions. At the next session, the heparin is drawn off so that the catheter can be used again.

Looking after the central venous haemodialysis catheter

The following will help you avoid problems:

  • Do not get the tube caught up in clothing - tape it securely to your child's skin. Your dialysis nurse can also provide your child with a tubular bandage vest to keep the catheter secure.
  • Do not remove or fiddle with the caps of the catheter – they are there to prevent any infection entering the blood system.
  • Ensure the clamps on each limb of the line remain clamped.
  • Use the central venous haemodialysis catheter for dialysis only. If you are

    admitted to your local hospital, please ensure that they do not use your child’s catheter without speaking to a nurse on Eagle Ward first.

Before you go home 

You will be given an emergency pack to take home with you. This should contain:

  • sterile gauze

  • alcohol wipes

  • spare white caps

  • spare dressings

  • blue clamps

One of the nurses will provide the pack and teach you how to use it before you leave the hospital.

The emergency pack should be with your child at all times. This is so that any problems (see below) can be dealt with safely while you travel to hospital for treatment. Older children can carry it with them and be taught how to use it. Younger children must have an adult with them at all times who will carry the emergency pack and who knows how to use it. Extra emergency packs can be provided to left at your child’s school.

What if...?

Problems with central venous haemodialysis catheters are rare, but it’s a good idea to know what to do if a problem does crop up.

The cap comes off 

Using clean hands, replace it with a clean cap and inform the hospital on the contact number below immediately. Your child may need antibiotics intravenously. 

The dressing comes off 

Using clean hands, apply a new dressing from the emergency pack. Inform your dialysis nurse when you next attend for treatment so that it can be cleaned, changed and reviewed.

The catheter is pulled 

Make sure the catheter has not been pulled out or knocked and that the cuff is not showing. If all is well, tape it securely. If all is not well, tape it securely to keep the remainder of the catheter in place and ring the hospital on the contact number given.

The catheter is damaged 

Clamp the line above the damaged area using a blue clamp. Using clean hands, wrap an alcohol wipe around the damaged area. Inform the hospital immediately on the contact number given below. The catheter will need to be replaced and your child will need antibiotics intravenously.

The catheter falls out 

If the exit site is bleeding apply firm pressure over the exit site and the incision site on the child’s neck using the gauze provided in the emergency pack. If the exit site is bleeding profusely, that is blood is soaking through the gauze within 30 seconds please dial 999 for an ambulance. Ensure someone continues applying pressure to the exit site.

If the bleeding is minimal, check after five minutes to see if it has stopped. If it has not stopped continue applying pressure until it does, checking at five minute intervals. If the bleeding gets worse or it has not stopped after 30 minutes, either call an ambulance or attend your local A&E department for treatment.

Once the bleeding has stopped, please apply a dressing over the exit site. Continue to monitor the exit site for bleeding until you receive medical help. Ring the hospital on the contact number given so that the catheter can be replaced.

The exit site looks infected 

Inform the hospital on the number given and arrange to come in to have a swab taken. Your child may need intravenous, oral or topical antibiotic treatment.

Your child has a temperature (fever) >38ºC 

Phone the hospital immediately on the number given for advice. Your child may have an infection inside the catheter which can cause septicaemia and make them very unwell. You child will need to have blood samples taken from the line and may need intravenous antibiotics.

Compiled by: 
The Nephrology department in collaboration with the Child and Family Information Group.
Last review date: 
March 2013
Ref: 
2012F0760

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.