Dialysis line intervention

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. There are a number of 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 intervention?

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.

Dialysis line intervention

This procedure is necessary if your line blocks or does not work as well as it should.

There are 2 types of intervention Line Rodding and Line Stripping. In either case you will be taken into the x-ray room, and asked to lie flat on the table.

Line Rodding

This can be likened to “rodding pipes” in plumbing. The Line will be cleaned with an antiseptic fluid and you will be covered in a sterile drape. A wire will be used to clean (rod) the inside of the dialysis line and saline will be used to flush the Dialysis line through to ensure the intervention is successful. In 80% of cases this will be a successful examination.

Line Stripping

This is a more invasive procedure to clean the dialysis line requiring a puncture into the vein in the groin. The area where the puncture is to be made 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 this may sting a little as it goes in and then go numb.

A special access tube will be placed in the puncture, through this a special wire with a loop (a Snare) is inserted and positioned over the dialysis line, then the Fibrin (a tough protein substance) made by the body, is stripped away from the line to improve its function. This examination may also be combined with the above line rodding examination for the best results.

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 intervention?

Line Rodding

After the line rodding you will go to the radiology day unit for about 20 minutes. You will be offered a cup of tea or coffee. 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.

Line Stripping

If you have a Line Stripping Procedure you will be required to stay for 2 hours bed rest after the examination before being discharged home.

It is advised that if you have this examination, you will require someone to bring you and take you home as you will be unable to drive.

Keeping your Dialysis line working

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.

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.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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