Caring for your dialysis line

What is a dialysis line?

There are two types of dialysis lines;

• A Temporary Central Venous Catheter (CVC), depending on its location this will stay in place no more than 7 (femoral) – 21 (neck) days
• A Tunnelled CVC, this can stay in situ as long as it is required/functioning (approximately 1-2 years).

A temporary CVC will only be used whilst you are an inpatient and will be removed prior to your discharge home.

Your dialysis line is a flexible tube, which is put into one of the veins in the neck and held securely in place by a cuff under the skin or by two stitches. Following insertion a chest x-ray will be done to check the position of the line. Once the line position is confirmed then it can be used for dialysis. The line is divided into two ‘lumens’. During dialysis blood flows to the machine through one lumen and back into your body through the other lumen.

Your line provides a way for the dialysis machine to clean your blood. The point where the tubing enters the skin is called an ‘exit site’.

For most patients a CVC is a temporary solution and if you are going to be on dialysis for the long term our staff will discuss more permanent ways to access you blood, known as a Fistula or Graft. These are easier to care for and less restrictive than a dialysis line.

Reducing MRSA/MSSA on your skin

Prior to insertion of your dialysis line you will be prescribed a 5-10 day course of antiseptic wash and an antibiotic nasal cream. You MUST start this treatment before the line is inserted. If the course has not been completed then you must continue the course after the line is inserted, until you have received the full treatment. If you develop red or itchy skin please do not stop using the wash, instead contact your doctor/nurse.

MRSA/MSSA decolonisation

The decolonisation involves washing your skin and hair with special antiseptic soap, and applying cream to both of your nostrils. If you are to have an invasive procedure, such as insertion of a central venous catheter, you will be asked to start decolonisation prior to the procedure. If you have a holiday planned, the unit where you are receiving treatment may ask for you to receive decolonisation prior to attending their unit.

You will be prescribed a five day course of skin wash and an antibiotic cream (5-10 days dependant on product prescribed). If you are undergoing a planned procedure, your five day body wash should finish on the day of your procedure.

These products are:

A body wash/shampoo that contains Chlorhexidine*. It is gentle on the skin and can be used by people with sensitive skin.

An ointment which contains 2% Mupirocin* for putting in both nostrils.

*alternative products are available for those with allergies.

How to use nasal cream

You will need to use the cream three times a day for five days. Wash your hands and then place a small amount (about the size of a matchstick head) on your little finger or cotton bud and apply to the inside of your nose.

Repeat this on the inside of both nostrils. Press the sides of your nose together, this will help to spread the cream in your nose properly. Once you have completed this, it is important to wash your hands thoroughly.

How to use body wash

You will need to use the body wash for five consecutive days. If you have an open or infected wound please cover with a waterproof dressing.

1. Ensure body and hair is totally wet.
2. Step out of running water and apply undiluted body wash to your wet skin, with either hands or a cloth.
3. Start with you face and work downwards, paying particular attention to the areas around your nose, armpits and groin. Avoid contact with eyes and ears. Do not use the antiseptic wash inside your body.
4. Rinse the body wash off.
5. Dry off with a clean towel – do not share towels.
6. Put on clean clothing.

Looking after your dialysis line

Looking after your dialysis line may prevent complications and help it last longer.

• It is important to keep your dressing clean and dry (the picture above shows a clean dressing over the entry site).
• The nursing staff will check your exit site at each visit. Dressings are usually changed weekly, unless they are soiled or the site looks infected. Only change the dressing at home if absolutely essential and if you have been trained to perform this task. You may need to obtain a supply of film dressings from your GP should you require frequent dressing changes at home. If you need to change the dressing wash your hands thoroughly before removing the old dressing and put it in the household waste. Re-wash your hands and apply the new dressing, without touching either the exit site or internal section of the dressing. Apply the date sticker to the dressing along with a letter “H” to indicate that the dressing has been changed at home. If you cannot apply a new dressing contact your dialysis unit.
• During dressing changes and when your line is being connected/ disconnected, please avoid breathing or coughing over your CVC to help reduce the risk of germs entering the bloodstream.
• Avoid getting your line and dressing wet. For example do not cover with water and take care when showering. Specialist pouches are available to purchase on the internet which can be used to protect the line whilst showering; although many people prefer to direct the flow of water away from the line and cover with a towel to limit moisture to the dressing.
• We do not advise swimming or immersing the line in water.
• Avoid using talcum powder and creams around the dialysis line site.
• Do not shave the skin around the insertion site as this can cause some trauma to the skin layer making it an increased risk of infection.
• Keep sharp objects, including scissors, away from the line.
• Avoid pulling or kinking the dialysis lines.
• You can wear a vest or a cropped bra under your clothes to help keep your line close to your chest. If you need a securing device to stop the line moving, please talk to your dialysis team. Securing devices should be used for at least four weeks after line insertion. Care is required if participating in contact sports. Please discuss with your dialysis team if required.
• Ensure that the clamps and caps remain closed at all times when your dialysis line is not being used for dialysis. These prevent air and germs from entering the blood stream. Do not let people other than your dialysis team handle or touch the line (especially young children).
• Your dialysis line should not be used for any purpose other than dialysis.
• Sometimes CVC’s can become blocked, and will need medication inserted in to the line to help unblock the line.
• ONLY let staff from the haemodialysis service access your line.
• WARNING: your dialysis line may contain Heparin. It is
• important that you (or a relative) inform any healthcare staff that may need to access this line in an emergency to take bloods or administer urgent medication. Any Heparin in the line needs to be removed before this can be done.
• Immediately tell your dialysis team if you notice:
• The skin around your dialysis line is sore, red or has a discharge.
• You have fevers or chills.
• You are generally unwell.
• There is pain or swelling around the line site.
  
  These symptoms could indicate that you have a serious infection and it must be treated urgently as you may need intravenous antibiotics. Contact your renal unit urgently if:
• There is bleeding from or around the tube.
• Apply pressure to the exit site, and contact the renal unit for advice. If you are unable to control the bleeding please call 999.
• If a clamp/cap has broken or fallen off or
• There is a hole/ tear in the dialysis line.
  Apply a firm pressure above the hole/ tear or where clamp has fallen off to prevent air from entering the blood stream, call 999 and lie down on your left side with your feet up and head down until help arrives. This is to help prevent any air in your blood stream from causing any damage.
• If the skin has broken open over the line tubing or
• Your dialysis line has fallen out – You will need to:
  Lie down and apply firm pressure using a clean towel or item of clothing to the exit site (where the line has become dislodged). Phone 999 immediately.
• If your line has changed in position or length
  Never attempt to push it back in as this could lead to a serious infection or go into the wrong part of the body. You will need to come in to the unit to fix this.

How long should my dialysis line remain in place?

Your dialysis line should remain in place until your doctor has given you are a more permanent form of access.

There are two other most common types of vascular access;

• Arterio Venous Fistula (AVF) – called a fistula
• Arterio Venous Graft (AVG) – called a Graft

It is recommended that an arteriovenous fistula/graft (AVF)should be formed where possible. This is where a surgeon connects an artery directly to a vein, causing more blood to flow through the vein. As a result, the vein grows larger and stronger. This makes it easier to make the required needle insertions for haemodialysis treatment.

Dialysis lines are therefore usually a temporary measure or used when clinical need dictates, for example if a fistula or other access isn’t working.

Once you are no longer in need of your dialysis line arrangements will be made for it to be removed as quickly as possible.

Further information

If you have any questions or concerns about your dialysis line then please contact the following: