• Reference Number: HEY-868/2021
• Departments: Renal Service
• Last Updated: 19 May 2021

Introduction

This leaflet has been produced to give you general information following insertion of a tunnelled haemodialysis line.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a tunnelled haemodialysis line?

Dialysis is a treatment to replace some of the essential functions which your kidneys can no longer provide.  A tunnelled haemodialysis line (also known as a tunnelled line) is a small soft plastic tube inserted through the skin into a large vein in your neck or at the top of your leg.  This is used to connect you to a dialysis machine.  The tunnelled haemodialysis line is usually made up of two narrow tubes which are either separate or joined together.  This is so that blood can be taken out of the body through one tube and returned to the body through the other tube.

Why do I need a tunnelled haemodialysis line?

The tunnelled haemodialysis line is used to connect you to a haemodialysis machine.  The machine removes the waste products and excess fluid that the kidneys cannot remove.  This is required because your kidneys are damaged to the extent that they need the machine to take over their normal function.

The tunnelled haemodialysis line can be kept in for several weeks or months until a more permanent access like a fistula (please see separate leaflet ‘Formation of Fistula for Haemodialysis’) is created as this is the best way to give you dialysis.

Post tunnelled haemodialysis line insertion

Date of insertion: ……./……./………

Line locking volume:  A = ……………mls. V = ……..……mls.

Sutures (stitches):

In the neck to be removed after day 7.  Date: ……./………/……..…

Sutures around the line to be removed after 21 days. Date: …..…/……../…….…

Will I be in pain post tunnelled haemodialysis line?

Your neck and shoulder may be sore for a couple of days.  Mild pain relief can be taken for this, for example paracetamol.  If the pain is persistent or feels like it is getting worse, please inform your nurse straight away if you are an inpatient.

If you are an outpatient, please contact:

Hull Haemodialysis Unit – (01482) 608748 or  Out of hours – Ward 50, Hull Royal Infirmary – (01482) 675050

Dressing change

Your dressing will be changed within 24 hours of initial insertion.  This will be completed by the nurse caring for you on the ward if you are an inpatient.  If you are an outpatient then this will be completed at your next dialysis session.

Who will care for my tunnelled haemodialysis line?

While in hospital your tunnelled haemodialysis line will be looked after by the nursing staff on the ward.  This involves:

• Cleaning the exit site and applying a new dressing at least once a week.

• Checking the tunnelled haemodialysis line and the area it enters your body   every day for any problems with the tubing or exit site.

After discharge from hospital the tunnelled haemodialysis line will be cared for by your haemodialysis nursing team.

Care of your tunnelled haemodialysis line at home

Showering:

Keep the dressing dry. Cover the line and dressing area with a clean plastic bag using medical tape to apply. Do not immerse that area directly under the water.

Having a bath:

Bath water is not as clean as shower water so if you have a bath you must ensure the exit site and end of line are kept out of the water.

Sports:

Many sports like tennis, golf or strenuous gym exercises should be avoided. There is a risk your tunnelled haemodialysis line could become dislodged due to a lot of upper body movement.

Do not go swimming with a tunnelled haemodialysis line as you would not be able to keep the exit site or end of the line out of water and would increase the risk of infection.  Your doctor / nurse can advise you about other sports that are acceptable.

In the longer term, an arterio-venous fistula (AVF) will be placed and the above will not be an issue.

Exit site:

To prevent infection your tunnelled haemodialysis line must be kept clean and dry at the exit site and the dressing changed once a week or more frequently if the dressing becomes soiled, loose or wet.

Possible problems

You should contact the vascular access nurse on telephone number (01482) 608709 or, out of hours, please contact Ward 50, Hull Royal Infirmary on telephone number (01482) 675050.

Infection: It is possible for an infection to develop inside the tunnelled haemodialysis line or in the area where it goes into the vein. If you notice any swelling, or redness, along the vein above the insertion site contact the above.

Leaking blood: This is rare but if you notice any leaking from the tunnelled haemodialysis line it may be a hole that has developed in the line.  Attend your local Emergency Department.

The tunnelled haemodialysis line breaks or you accidentally cut the line: You must NEVER use scissors near the line.  If you notice a cut or tear in the line, attend your local Emergency Department.

Air in the tunnelled haemodialysis line entering the bloodstream: You may suddenly have difficulty breathing, experience chest pain, dizziness or confusion.  Clamp the line if it is not already clamped.

• Contact the emergency services (dial 999) to attend your local Emergency Department.

• If possible, lie down with your head lower than your hips and feet until  assistance arrives.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Hull Renal Dialysis Unit (01482) 608748 or Ward 50 Hull Royal infirmary (01482) 675050