Interventional Radiology and Fluoroscopy
What are dialysis lines?
Dialysis lines are venous lines used to allow haemodialysis – a medical procedure that uses a special machine (a dialysis machine) to filter waste products from the blood and to restore normal constituents to it.
A dialysis line can be inserted into a blood vessel (vein), in the neck (jugular vein), upper chest (subclavian vein) or in the groin (femoral vein). The tip of the dialysis catheter is placed into a large central vein.
The dialysis lines have two channels that allow dialysis to occur from a dialysis machine.
Are there any risks?
Complications are very uncommon and dialysis line insertion is a safe procedure.
- As an artery accompanies every vein, it is possible to puncture the artery inadvertently. The lung is also very close, and it is possible to puncture the lung (pneumothorax). These are extremely uncommon, and the risk is about 1%
- Dialysis lines can migrate in the first two weeks while the Dacron cuff on the line anchors it in place
- There is a small risk that an infection may occur due to insertion (within 14 days), but the greater risk is subsequent infections. These later infections can occur in two ways –in the tunnel track or within the line itself. Tunnel track infections can usually be treated successfully with antibiotics; unfortunately, if your line becomes infected within, it may need to be removed. To avoid infections, you must try to keep the skin around the line dry, clean and covered. Do not allow anyone to use the line who does not take all the sterile or non touch precautions.
There are several complications that may occur after weeks to months following insertion.
- Venous thrombosis (blockage of the vein with clot) occurs in approximately 2 to 8% of cases. Thrombosis and clots in the veins are very rare. They can cause arm swelling or prevent blood being taken from the line
- If your arm or leg becomes swollen, you should contact your doctor as soon as possible. If the line is in place for a long time, breaks and damages can occur, although this is rare. The line may need to be replaced for these reasons.
What do I need to do to prepare for the procedure?
You can come into hospital, have a Dialysis line inserted and intervention, and go home the same day.
- You will usually need to have a blood test to measure full blood count and clotting before the procedure. Your doctor or clinic nurse specialist will tell you how to arrange it when they recommend a dialysis line or intervention
- Please let us know if you are taking any medicines that thin the blood (for example Warfarin, Rivaroxaban, Dabigatran, Apixaban), as these may need to be withheld temporarily before the procedure. Call the Radiology Day Unit Sister for advice as soon as you get your appointment letter on 01642 854332.
You do not have to stop eating before the procedure, but you will be lying flat, so you should not have a large meal. You may drink water up to the procedure.
What happens before the dialysis line insertion?
After you have arrived at the radiology day unit, you will be examined and assessed by a radiology nurse and given a hospital gown to wear.
You will be seen by a radiologist or radiographer (a health care professional who uses imaging machines to diagnose and treat illnesses) who will discuss the procedure with you. You will be given the opportunity to ask any questions you have.
Giving my consent (permission)
The staff caring for you will ask your permission to perform the procedure. If you decide to go ahead, you will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.
How is the dialysis line inserted?
You will be taken into the x-ray room and asked to lie flat on the table. Your neck will be checked for a suitable vein using a small ultrasound machine. We usually use the right side of your neck or chest. The area where the line is to be inserted is cleaned with an antiseptic fluid and you will be covered with a sterile drape.
The radiologist or radiographer will inject some local anaesthetic into your skin on your chest and neck to numb the area. This may sting a little as it goes in and then go numb. After this you should only feel pressure not pain. Throughout the procedure a nurse will be with you to monitor your pulse and blood pressure.
A small cut is made in the skin near your collarbone (the entry or insertion site) and a second small cut is made on the chest wall (the exit site). The line is threaded under the skin from the exit site to the entry or insertion site, passed into a large vein at the entry or insertion site and the tip advanced through the large veins to lie just above the heart.
There is a small ‘cuff’ around the Dialysis line which can be felt under the skin just above the exit site that prevents it from falling out. The tissue under the skin grows around this cuff over a period of about three weeks and holds the line safely in place. Until this has happened you will have a stitch holding the line in place.
Will I feel any pain?
As you are given a local anaesthetic, you should not feel any pain during the procedure. You may however feel some discomfort after the procedure when the local anaesthetic wears off. You may want to take paracetamol tablets for the pain. You may also have a little bruising.
What happens after the dialysis line insertion?
After the line placement you will go to the radiology day unit for about 20 minutes. You will be offered a cup of tea or coffee. The line insertion should be no worse than having a ‘filling’ at the dentist. You may drive yourself home, but some patients prefer to be driven. We are happy for you to use public transport if that is convenient to you.
Taking care of your dialysis line at home
Showering
Use a waterproof dressing over the exit site as this will keep it dry during a shower. We will provide some dressing and advice how to use them after you leave hospital. You will generally need a dressing for the first two or three weeks after the insertion. Afterwards, you only need one when showering to keep it dryHaving a bath
Bathwater is not as clean as shower water so if you have a bath, please make sure that you keep the exit site out of the water for example, by sitting in a shallow bathSports
Most sports are fine after the first few days. Once it has settled in going to the gym is fine. We advise you to avoid contact sports. Gardening, cleaning, cooking, decorating etc. should not be problemSwimming
You are not able to swim with a Dialysis line in placeWhen in a car, wear your seat belt in the conventional way
Air travel is not a problem
Keeping your dialysis line working
The Dialysis line can be used as soon as it is inserted. If your line is not being used, the plastic clamp must stay closed. Remember to check it is closed every day and that the stopper on the end is securely attached.
Your line will be flushed regularly before and after dialysing to prevent it becoming blocked. This will be done in the ward or day unit when you get your treatment.
How will I know if something is wrong with my dialysis line?
If you experience a cold and shivery attack during or after flushing your line, contact the doctor or nurse caring for you immediately. This could be due to an infection in the line. The line is in a large vein close to your heart, so it is important to treat any infection as soon as possible.
Important
You should also contact the hospital straight away if:
- You experience pain, redness or swelling in your arm or neck on the same side of the body as your line
- The cuff or line has moved
- You feel breathless
- Your line becomes damaged or develops a leak
- Becomes difficult to use.
Useful websites
Please visit: https://www.kidney.org.uk/dialysis-line-insertion
Radiation dose and risk
X-rays use ionising radiation which can cause cell damage that may, after many years or decades, turn cancerous. The risk of this happening is very small compared to the normal lifetime risk of developing cancer which is 1 in 2.
We are also all exposed to background radiation every day. The risk of long-term effects is considered when the healthcare team decide whether someone needs an x-ray examination and radiation doses are kept as low as possible.
For this examination radiation dose levels are typically equivalent to around 1-2 years of background radiation. The associated risk is less than 1 in 1000 – Low.
Is there anything I should tell the staff?
For patients who have ovaries and are between the ages of 12 and 55, the x-ray department has a legal responsibility to ensure that this examination is performed within TEN DAYS of the first day of your menstrual period.
Contact us
If you require further information, please contact us on:
Telephone: 01642 854822
Email: [email protected]
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