Haemodialysis line insertion
This leaflet tells you about having a dialysis line inserted for haemodialysis treatment. Please read it while talking to your doctor.
Dialysis line insertion
What is a dialysis line insertion?
Dialysis line insertion means having a soft plastic tube (see pictures below) placed through the skin into one of the large veins in the neck or the groin at the top of the thigh.
Why would you need to have a dialysis line insertion?
A dialysis line is usually inserted because your blood tests have shown that your kidneys are not working properly and are not removing poisons from your body. The dialysis line takes blood from your body and puts it through a machine that filters out the poisons and removes excess water. The process is called haemodialysis.
This may avoid you developing serious complications from kidney failure such as breathlessness or heart problems including your heart stopping beating.
Types of haemodialysis lines
There are two types of dialysis lines and the choice mainly depends on the clinical setting and urgency.
Tunnelled lines take longer to insert. They are embedded under the skin to try to prevent infections. These lines can stay in for longer.
Temporary lines are quick to insert and are used for short periods of time (days).
Where is it done?
The dialysis line will usually be inserted whilst in a procedure room in Brantham Ward, Rushmere Medical Day Unit or the X-ray Department.
How long does it take?
Temporary lines usually take around thirty minutes to insert, whereas tunnelled lines can take up to one hour. Insertion is done under local anaesthetic so you will remain awake.
Before the procedure
Eating and drinking
You can eat and drink normally unless you have been told not to do so.
Blood thinner medications
Please let us know if you are taking any blood thinner medications for example aspirin, clopidogrel, warfarin, apixaban etc. If unsure, please ask.
We may need to give you medications during the procedure; therefore please let us know if you have any allergies.
During the procedure
- Before the line is inserted, you will be asked to change into a hospital gown.
- You will be asked to lie flat on your back on the bed with your neck turned to one side for a neckline insertion. You will need to stay in this position for the procedure. Please let us know if you may find this difficult.
- We will scan your neck or groin to find the exact position of the vein. You may feel some pressure from the ultrasound probe, but it will not hurt.
- The skin will be cleaned with antiseptic solution which will feel wet and cold for a few seconds.
- You will be covered with a sterile sheet to minimise infection.
- To numb the skin, local anaesthetic will be injected which you will feel as a sharp scratch and then it will sting a little. You should not then feel any pain but will be aware of pushing or pulling sensations as the line is inserted, in particular with tunnelled line insertion. If you feel pain, please let us know and we will give you more anaesthetic.
- Once the line is inserted, we will put a small amount of drug in the line to keep it open. This may cause you to experience a metallic taste for few seconds.
- The line is held in place with some stitches and a protective dressing is applied.
After the procedure
- If the dialysis line has been placed into a vein in the neck you will have a chest X-ray to confirm the line position.
- After the local anaesthetic has worn off you may feel a little discomfort around the dialysis line due to slight bruising. It usually settles within 24 hours and paracetamol will help.
- Blood thinning medication can usually be restarted the day after the procedure. The doctor inserting your dialysis line will confirm this with you.
- Eat and drink normally before and after the procedure.
- We will arrange for the stitches to be removed at dialysis sessions. The skin stitches at the line entry site can usually be removed after 7 to 10 days whereas the ones around the line exit site should be removed in around 21 days.
- Occasionally the stitches at the exit site will need to stay in place for as long as the line is in place.
What are the risks of a dialysis line insertion?
Dialysis line insertion has a small risk of complications and we take precautions to minimise those risks.
- Bleeding: There may be some ooze from the exit site; this is more common if you have been on blood thinners. Less commonly the bleeding may occur from damage to a vein, artery, or surrounding structures. This is usually controlled by applying pressure to the puncture site but may result in some bruising. Rarely it requires a blood transfusion or an operation to stop the bleeding.
- Infection: Infection can affect the exit site or occur in the blood stream. This is usually treated with antibiotics with or without line removal.
- Unsuccessful line insertion: Sometimes the line cannot be inserted because of a blockage or narrowing of the vein. If this occurs, we will arrange a further attempt with the help of an X- ray consultant, where special imaging is available.
- Rare complications of neckline insertion: The procedure may be complicated by air (pneumothorax) or bleeding (haemothorax) around the lung, both of which require a tube to be inserted into the chest for a few days to re-inflate the lung. In exceedingly rare situations surgery might be required.
What happens if I start bleeding around my dialysis line?
Immediately report any bleeding from the exit site.
- If there is only a small amount of bleeding apply pressure to the exit site and contact Ipswich Dialysis Unit, which is open Monday to Saturday, 7am–11.30pm, on 01473 704 027.
Outside these hours, please call 111 for further advice.
- If the bleeding is heavy or does not stop, call 999 for an ambulance to take you to the nearest hospital with an accident and emergency department.
How to take care of your dialysis line
- Avoid exercise which involves movement of your neck for approximately one to two weeks until wound healing has taken place.
- Keeping the dressing dry is important to minimise infection. You can wash and bathe, but a waterproof dressing may need to be applied where the dialysis line enters the skin. It is important that the catheter is never submerged in water. You should not swim with a dialysis line in place.
- The line should not be used for any purpose other than dialysis unless it is a medical emergency. All persons using the line must have received training in its use.
- Line infection – Immediately report any signs of swelling, tenderness, fever, pain or oozing from the exit site to the nursing staff on the dialysis unit on 01473 704 027.
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