How to take care of your dialysis catheter

How to take care of your dialysis catheter

Haemodialysis is a treatment used when your kidneys fail and they can no longer clean your blood and remove extra fluid from your body. Haemodialysis access or vascular access is a way to reach your blood for haemodialysis.

If you receive haemodialysis, your access is one of the following:

• an arteriovenous fistula (AVF) made by directly joining together an artery and vein in your arm
• an arteriovenous graft (AVG) made by using a soft tube to join an artery and vein in your arm
• a catheter (a soft tube) that is placed in a large vein, usually in your neck

The Vascular Access Society of Britain and Ireland (VASBI) in partnership with the British Renal Society (BRS) recommends the AVF as the preferred choice for permanent vascular access. The catheter is for temporary access due to increased risk of infection and insufficient dialysis clearance.

What is a haemodialysis catheter?

The catheter used for haemodialysis is a tunnelled catheter, because it is placed under the skin. There are two types of tunnelled catheters: cuffed or non-cuffed. Non-cuffed tunnelled catheters are used for emergencies and cuffed tunnelled catheters for temporary access, although they can be used for longer than three weeks. If you are dialysing via a tunnelled catheter, speak to your dialysis nurse to discuss any potential life-threatening complications that may occur. We strongly recommend dialysing via an AVF.

How do I take care of my catheter?

By taking good care of your access, it will last longer and you will prevent problems such as infection and clotting. Here are some important steps to take:

• Keep the catheter dressing clean and dry.
• Stitches should not be removed within 15 to 21 days of line insertion, until the cuff has grown underneath your skin.
• Make sure the area of the insertion site is clean and your care team changes the dressing every dialysis session for the first two weeks after line insertion and weekly after two weeks.
• The exit site should be covered with a bio-patch for the first two weeks only, although this could be left on for longer if the exit site is still in the process of healing.
• Keep an emergency dressing kit at home, in case your line is accidentally pulled out. If this happens, put pressure on the exit site by pressing on it using a piece of gauze or any piece of cloth. A pack of gauze will be provided by your named nurse. In an emergency situation where you do not have the gauze pack to hand, please use a piece of cloth or similar material that you can use to press on the catheter exit site. Call 999.
• Never remove the cap on the end of your catheter. Air must not enter the catheter.
• Speak to your named nurse for advice on showering. It is possible to shower if you have a clear dressing that sticks to your catheter site and apply a pouch bag to keep the exit site clean while showering. This type of dressing and bag is recommended because it’s waterproof, which helps prevent infection. It can be supplied by your named nurse.
• The caps and the clamps of your catheter should be kept tightly closed when not being used for dialysis. Only your care team should use your dialysis catheter to draw blood or to give medications or fluids.
• If the area around your catheter feels sore or looks red, call your dialysis care team. Ask your dialysis team about signs and symptoms that require immediate attention.
• Know your Kt/V and URR (urea reduction ratio). Kt/V and URR are numbers that tell you how much dialysis you are getting. If you are receiving enough dialysis, your Kt/V should be at least 1.3. If URR is used, it should be 65% or more. If your numbers are too low, one possible cause may be that your access is not working well. Ask your dialysis team to check your access.

Should I have any concerns about my catheter?

Sometimes, even when you are very careful, there is a chance that your catheter may clot or become infected. This is why we recommend using an arteriovenous fistula as access for haemodialysis.

Clots can form inside the opening of the catheter or form on the outside of the catheter and block the opening. This can cause blood to flow at a slower rate than the rate your doctor ordered. If the blood flow rate remains low for more than one dialysis treatment, the catheter should be checked and treated the same day. Early treatment may prevent the clot from totally blocking the catheter. It is important to restore the recommended blood flow rate and treat clots that are forming so that your catheter continues to work well and you get the amount of dialysis you need.

Infection can also occur even with a good blood flow rate. It is important to follow your catheter care instructions, exactly as you were taught, to avoid infection. You should be aware of the signs and symptoms of catheter infection and report them to your doctor or dialysis team right away, so you can get the proper treatment as quickly as possible.

The signs and symptoms of a catheter infection include:

• fever
• chills
• drainage from the catheter exit site
• redness or tenderness around the catheter exit site
• general feeling of weakness and illness

Treatment depends on the type of infection but may include:

• an ointment applied directly to the infected area if it is an exit site infection
• antibiotic medication if there is drainage from the exit site
• an intravenous (IV) antibiotic (a solution containing an antibiotic that is administered directly into a vein) if the infection has spread to the blood

What happens when my catheter is not working well?

A decrease in the blood flow rate ordered by your doctor is a sign the catheter is not working as it should. If this occurs for more than one treatment in a week, the catheter should be checked. The lower blood flow rate will cause you to receive less dialysis. You will then need a longer than usual haemodialysis treatment to get the proper amount of dialysis.

Another sign that your catheter is not working well may be that the pre-pump arterial pressure alarms. These sounds notify the care team that your catheter (or other vascular access) is not allowing a free draw of blood. This can be a sign that a clot is forming in the catheter blocking the flow of blood.

What can be done to remove the blockage from my catheter?

Treatment is the administration of a “clot-busting” medication called tissue plasminogen activator (tPA). It can be done in the satellite unit, no need for you to travel to Addenbrooke’s to have this procedure done; nurses can give the medication while you are in your dialysis chair, thus preventing a long journey and hospital admission. If you are at the end of your treatment, tPA can be given just before your next dialysis appointment. Another form of treatment is by giving you anti-thrombotic drugs which aim to dissolve the clot. If the clot is not treated when signs and symptoms of an early clot are found, the catheter can eventually become fully clotted. You may then be required to visit the vascular access unit or the renal clinic in Addenbrooke’s to have the catheter checked and possibly exchanged for a completely new catheter.

What are the benefits of treating the clot early?

• By restoring your blood flow, haemodialysis can work as it should to remove the toxins and excess fluids from your body.
• Taking care of the clot early results in fewer treatment interruptions and improved quality of life on dialysis.
• Other benefits are the prevention of additional health problems and the chance to live longer on dialysis

What can I do to keep my catheter working well?

Learn as much as possible about your prescribed treatment plan including your blood flow rate, how often and how long you need treatments.

Follow the treatment plan:

• stay for your full treatment time
• keep your dialysis appointments
• arrive on time for your haemodialysis treatments

Ask your doctor how much dialysis you should be getting. Keep a record of your Kt/V and URR numbers. Talk to your dialysis team if your numbers are not as good as they should be.

Share your concerns with your doctor and dialysis team. You may want to ask them the following questions:

• How can I tell if my catheter is not working?
• What is the flow rate?
• Why does the flow rate for my catheter need to be at this level?
• If my flow rate should go down, when will I be given clot-dissolving medication?
• Will the clot-dissolving medication interrupt my dialysis treatment? If so, what will happen to the rest of my treatment?
• How will you put the clot-dissolving medication in my catheter? How long do I have to wait for it to work?
• What are the signs and symptoms of infection?

If you have any questions or anxieties, please feel free to ask a member of staff including:

Clinical nurse specialist: 01223 400182 (direct line) Monday to Friday 07:00 to 15:00 (3pm)
Addenbrooke's Dialysis Unit: 01223 256342, Monday to Saturday 07:00 to midnight
Satellite dialysis units: Monday to Saturday 07:00 to 20:00 (8pm)

• Hinchingbrooke HD Unit: 01480 421850
• West Suffolk HD Unit: 01284 721921
• Kings Lynn HD Unit: 01553 613544

References / Sources of evidence

Kidney Care UK (opens in a new tab) [date accessed 01/07/2020]

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