What is a haemodialysis line?

In this article we will describe what is a haemodialysis line.

A haemodialysis line (or catheter) is a soft plastic tube (twice the length and half the width of a pen) placed through the skin into one of the large veins in the neck (usually) or the groin at the top of the thigh.

Photo. Courtesy of Cambridge University Hospitals

A haemodialysis line is one method by which doctors can gain ‘access’ to your bloodstream to carry out haemodialysis.

Once the haemodialysis line has been inserted and made secure, it can be connected to the tubes on the haemodialysis machine; this allows blood to be pumped from your body to the machine and back for dialysis.

Where is it done?

The haemodialysis line insertion will usually be carried out in a special procedure room on the ward, the operating theatre or the x-ray department. It will usually take less than thirty minutes and be done under local anaesthetic, so you will remain awake. You can eat and drink normally before and after the dialysis line is put into the vein.

The external part of the line may be kept in place with stitches. The part of the line running under your skin has a small cuff of material on the inside which helps your body to form scar tissue. This helps to reduce the risk of infection and keep the line in place.

How can I look after my haemodialysis line?

It is important that you take care of your haemodialysis line to prevent infections and to make it last longer.

Avoid touching the line where it goes into your skin. If you do need to touch it, always wash and dry your hands before and after touching it.

The dressings around the insertion and exit sites of the line must be kept dry at all times. You should not have a shower until the wound heals and the stitches are completely dissolved or removed. Removal of any stitches usually happens around 14 days after you have your line inserted.

After the stitches are removed, you can take a shower, but make sure that the exit site is kept dry. Special pouches are available to protect the line while you shower. Please ask your dialysis nurse if you would like to try these as they may be able to provide them for you.

You will need to apply a new dressing after you shower. You can get these from your dialysis nurse who will also teach you how to apply them.

Other things you can do to help

Always wash your hands thoroughly before you put on a new dressing
Covering your line and exit site under water increases the risk of infection, so taking a bath and going swimming is not recommended
Your dialysis nurses will usually change your dressing once a week. Let them know if you have changed your own dressing in between or if the dressing feels itchy or uncomfortable
Do not use any creams or talcum powder around the haemodialysis line
Wear clean, loose-fitting clothes around your line and take care when dressing and undressing to avoid pulling on the line
Keep sharp instruments like scissors away from your line
Do not pull or tug on your dialysis line
Do not allow anyone other than a member of your kidney team to use your line.

How can I tell if something is wrong with my haemodialysis line, especially if it gets infected?

Your nurses will check your line’s exit site for signs of infection each time you go for dialysis. Infections can often be treated with antibiotics; but, if they are severe, your haemodialysis line may need to be removed.

Important. Contact your kidney unit immediately if you notice any of the following as they may be symptoms of infection:

A higher temperature than normal, fever, chills or shivering
Pain, itching, redness or swelling around the exit site
Discharge (e.g. blood or pus) from around the line
Cracks or leaks in the line.

If there is severe bleeding, or your line falls out, press on the insertion site (not the exit site) with a clean hand towel and call 999 for help or ask someone to take you to your nearest A&E Department.

What are the risks of haemodialysis line insertion?

Haemodialysis line insertion has a small risk of complications. The main risk is that the needle or guide wire or dialysis line can damage the vein or other parts of the body nearby such as an artery or the lung. This risk is reduced by the use of an ultrasound or x-ray machine so that the doctor/nurse can directly see where the line is being inserted.

The most serious risks from haemodialysis line insertion are bleeding from an artery and puncture of a lung. It is important that you tell your doctor if you have a problem with easy bleeding or bruising or if you are taking tablets that can affect bleeding such as WARFARIN, ASPIRIN, CLOPIDOGREL, or other agents like APIXABAN. You should also tell your doctor if you are allergic to antiseptic such as IODINE.

If the dialysis line insertion causes a lot of bleeding you might need a blood transfusion (the chance of this is less than 1 in 100) or very occasionally an operation to stop the bleeding (less than 1 in 1000).

If the dialysis line insertion causes the lung to be punctured you might need to have a tube inserted into your chest (called a chest drain) for a few days to allow the lung to expand (less than 1 in 100); or very occasionally (less than 1 in 1000) an operation would be needed to repair the puncture. Although deaths have occurred following complications of dialysis line insertion this is extremely rare.

What happens when I don’t need the haemodialysis line anymore?

If you have stopped receiving dialysis or are having haemodialysis through a fistula (a more permanent connection that is made by joining a vein onto an artery, usually in your arm), your haemodialysis line will be removed at your kidney unit.

Alternatives to a haemodialysis line

There are two alternatives, to a haemodialysis line, to gain ‘access’ to the bloodstream:

Arteriovenous fistula (AVF). This is formed during an operation. The surgeon joins a vein and an artery together in your arm
Arteriovenous graft (AVG). This is similar to a fistula but uses a plastic tube under the skin to connect the artery to the vein. They are popular in the USA.

Note. Both are better longer term access options for most long-term haemodialysis patients.

Remember that taking care of your access will help your access take care of you.

Summary

We have described what is a haemodialysis line. We hope it has been helpful.

Other resources

Haemodialysis line patient information leaflet (Cambridge University Hospitals)
What is an AV fistula?
What is an AV graft?

Last Reviewed on 14 May 2024