RENAL PATIENT INFORMATION HOW TO CARE FOR YOUR DIALYSIS CATHETER Advice for patients with a dialysis tunnelled catheter
How to care for your dialysis line What is a haemodialysis line? A dialysis line is a soft plastic tube placed through the skin into one of the large veins in the neck or the groin at the top of the thigh. Once the dialysis line has been inserted and made secure, it can be connected to the tubes on the haemodialysis machine to allow blood to be pumped from your body to the machine and back for dialysis. You may hear your line referred to as a catheter, this is the medical term for a line. You may also hear your line called your access, as it allows us to access your blood for dialysis. Lines have two lumens; one is red, referred to as the arterial lumen to take blood from your vein and out of your body to the dialysis machine, and the other one is blue, referred to as the venous lumen, that allows the cleaned or filtered blood to be returned to your body. How do I take care of my line? By taking good care of your line, it will last longer and you will help to prevent problems such as infection and clotting. Here are some important steps to take: Keep the line dressing clean and dry at all times Make sure the area around the insertion site is kept clean and dry Never unscrew the caps at the end of your line Do not shower or swim; you may take baths but keep the line and dressing dry The caps and the clamps of your line should be kept tightly closed when not being used for dialysis If the area around your line feels sore or looks red, inform the nursing staff. 3
Line dressings A dressing will be put over the area where the line goes into the skin, also referred to as the exit site. The dressing is put on by the dialysis nursing staff. The dressing must be put on in a specific way to prevent infection. For this reason we ask that you do not change your dressing at home. If, however, the dressing falls off, you will need to carefully place a new dressing where the line goes into the skin. To replace the dressing: Wash your hands thoroughly with hot soapy water for at least 3 minutes Dry your hands well using a clean towel Open the wrapper and remove the dressing Do not put the dressing down on any surface Remove the adhesive paper be careful not to touch the sticky side of the dressing Place the centre pad of the dressing over where the line goes into the skin Press down lightly around the edges of the dressing for it to stick down It does not matter if the dressing wrinkles do not attempt to lift the dressing to smooth it out. Should I have any concerns about my line? Sometimes even when you are very careful, your line may clot or become infected. Clots can form inside the line or form on the outside of the line 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 line should be checked. Early treatment may prevent the clot from totally blocking the line. It is important to restore the recommended blood flow rate and treat clots that are forming so that your line 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 the line care instructions above in order to avoid infection. You should know the following signs and symptoms of a line infection and report them to your doctor or dialysis nurse straight away so you can get 4
the proper treatment as quickly as possible. The signs and symptoms of a line infection include: Fever Chills Oozing from the catheter exit site Redness or tenderness around the catheter exit site. What happens when my catheter is not working well? A decrease in the blood flow rate is a sign the line is not working as it should. If this occurs during more than one treatment in a week, the line must be checked. The lower blood flow rate will cause you to receive less dialysis. What can be done to improve the blood flow rate? There may be a blood clot within or at the tip of the line causing the reduction in flow rate. Treatment is the administration of medication to break down the clot. Most dialysis centres can give this while you are on the dialysis unit, thus preventing an extra hospital visit. If this treatment is not successful, you may need to be admitted to hospital to have a new line inserted. At London Bridge Hospital, we use a locking solution called Citra-Lock to lock your catheter. This solution has been shown to reduce the rate of infections associated with dialysis catheters (line sepsis). It also works by reducing catheter clots. You may feel a slight metallic taste in your mouth, or slight tingling of your fingers and toes when Citra-Lock is put into your catheter for the first time, but this is NOT dangerous and will pass within one minute. Who do I contact about my haemodialysis line? If you would like to talk about your haemodialysis line, or have any other queries, please talk to your dialysis nurse. Adapted with permission from Barts Health 5
Where can I get more information? www.kidney.org Dialysis Unit Monday-Friday, 8.00am-6.00pm Saturday, 8.00am-4.00pm T: 020 7234 2261 E: dialysis@hcahealthcare.co.uk After hours: 020 7407 3100 DECT phone: 48000 6
Travelling to London Bridge Hospital Directions: London Bridge Hospital is situated on the south side of the River Thames. We are opposite London Bridge mainline and underground stations with easy access to the City. Train: London Bridge Station is serviced by trains from Kent and Surrey and offers direct connections to Charing Cross, Cannon Street, Waterloo East and Blackfriars Stations. Trains also connect directly on the Thameslink line. Underground: London Bridge Station is on the Jubilee Line and Northern Line (City Branch). Please take the Tooley Street exit. By Car: There are no car parking facilities available at the hospital. There is limited parking nearby. Patients can be dropped off and collected by car or taxi outside the main door of the hospital, where 15 minutes parking is available. Taxi: The hospital reception can book taxis for patients and visitors through our local taxi company, alternatively black cabs are available at London Bridge Station. Buses: There are numerous buses that pass by the hospital on Tooley Street, from London Bridge, or from outside the main entrance of London Bridge Station. 27-29 Tooley Street, London SE1 2PR Tel: 020 7407 3100 londonbridgehospital.london V1/07/15