What Is a Tunneled Dialysis Catheter?
A tunneled dialysis catheter, also referred to as a central venous catheter or central line, is a type of venous access used for hemodialysis. This form of access is most commonly used on a temporary basis, typically while a patient is awaiting placement or maturation of a more permanent access, such as an arteriovenous (AV) fistula or graft. In certain cases, tunneled dialysis catheters may serve as a long-term or permanent access option for patients who are not candidates for other forms of dialysis access.
A tunneled dialysis catheter is placed beneath the skin and advanced into a large central vein, most commonly the internal jugular vein and, less frequently, the subclavian vein. A portion of the catheter exits the skin just below the collarbone and remains outside the body for dialysis access. The catheter contains two separate lumens, one used to withdraw blood for dialysis and the other to return filtered blood to the body. Many tunneled catheters include a small cuff beneath the skin that helps secure the catheter in place and reduces the risk of infection.
Tunneled dialysis catheter placement is typically performed in an interventional radiology suite. The procedure is minimally invasive and requires only small skin incisions. One incision is made near the base of the neck to access the vein, and a second incision is made below the collarbone where the catheter exits the skin. Most patients require only local anesthesia, with or without mild sedation, and the procedure is usually completed within approximately one hour.
Benefits of Tunneled Dialysis Catheter Placement
Tunneled dialysis catheter placement offers several important benefits, particularly for patients who need immediate dialysis access or are not suitable candidates for other access types. These benefits include:
- Allows for immediate hemodialysis in patients with acute or advanced kidney failure
- Minimally invasive procedure performed on an outpatient basis
- Short recovery time with few side effects
- Easy removal once the catheter is no longer needed
- Eliminates the need for repeated needle sticks associated with fistulas or grafts
Types of Fibroids
Intramural Fibroids
Common type, grow within the muscular wall of the uterus, causing uterine enlargement.
Subserosal Fibroids
Create a bulge and pressure on surrounding organs on the uterus’s outer surface.
Submucosal Fibroids
Develop beneath the inner lining, protruding into the uterine cavity, leading to heavy menstrual bleeding.
Pedunculated Fibroids
Grow on a stalk inside or outside the uterus, causing symptoms based on location.
Symptoms of Uterine Fibroids
Menstrual Irregularities
Weighty and prolonged periods, longer or more frequent menstrual cycles, pelvic pressure or pain during periods.
Urinary and Digestive Issues
Frequent urination, difficulty emptying the bladder, constipation
Abdominal Changes
Growing stomach area
Pain and Discomfort
Pain in the stomach area or lower back, discomfort during sexual intercourse.
Serious Complications (Rare)
Sudden, severe pain if fibroids outgrow their blood supply and begin to die.
Risks Associated With Tunneled Dialysis Catheters
While tunneled dialysis catheters provide essential access for dialysis, they carry certain risks, including:
- Increased risk of infection
- Blood clot formation (thrombosis)
- Narrowing of central veins (central vein stenosis)
- Limitations on activities such as swimming or heavy lifting
- Reduced dialysis efficiency if adequate blood flow cannot be maintained
Because of these risks, tunneled dialysis catheters are generally not recommended as a long-term or permanent access option when alternatives are available.
FAQ
1. What Happens During Tunneled Dialysis Catheter Placement?
Before the procedure, your care team will review your medical history, perform a physical examination, and order routine laboratory tests. In some cases, additional testing such as a chest X-ray or electrocardiogram (ECG) may be required.
During the procedure, you will lie on a table that is slightly tilted (about 15–30 degrees). You will receive local anesthesia at the treatment site along with intravenous (IV) sedation to keep you comfortable. General anesthesia is rarely needed.
The skin in the lower neck area will be cleaned and numbed, and a small incision will be made to access the internal jugular vein. A guidewire is then advanced toward the vena cava. A second small incision is made below the collarbone on the same side, and a tunnel is created beneath the skin to guide the catheter from the exit site to the vein.
Using real-time X-ray (fluoroscopy) guidance, the catheter is advanced over the guidewire into the correct position. Once placement is confirmed, the guidewire is removed. One end of the catheter remains inside the vein, while the external portion exits below the collarbone. A chest X-ray is typically performed after the procedure to confirm proper placement.