Haemodialysis Central Venous Catheter (CVC)

This is a thin tube, also called a central line or central venous access which is inserted into one of the large veins near the heart.

Permanent Haemodialysis Central Venous Catheters have a cuff under the skin to help keep them secure and can be kept in place for a long time if needed.

Temporary Haemodialysis Central Venous Catheters do not have a cuff and only remain in place for up to 14 days.

The Haemodialysis Central Venous Catheter looks like one tube but it has two tubes within it to allow blood to be taken out from the body via one tube and returned via another.

At the end of the Haemodialysis Central Venous Catheter, yellow caps are placed and then wrapped in parafilm (which looks a bit like clingfilm) and then often wrapped in gauze when not in use. Your child will need to have an operation under general anaesthetic if it is a permanent line or sedation if it is a temporary line.

This is usually done by the Xray doctors (interventional radiologists) or surgeons.

An ultrasound is used to guide the catheter through a vein in the neck and into the top of the heart.

The Haemodialysis Central Venous Catheter is then tunnelled under the skin before it comes out on the skin. The place it comes out onto the skin is called the exit site, whereas the initial site they inserted the catheter on the neck is called the entrance site.

Part of the Haemodialysis Central Venous Catheter will be visible outside the body, it divides into two lumens (lines) so that it can be accessed for taking blood.

Your child will come back with a biopatch (a round circle disk) which has provides protection from infection at the exit site and a clear dressing over the site.

Your child may have some discomfort and bruising around the neck and shoulder area. Your child will be given pain relief to make him or her more comfortable. This should improve and settle down after a day or two.

Every anaesthetic carries a risk of complication The risks of this procedure are small, and the anaesthetic doctor will explain them to you before the operation.

After an anaesthetic some children feel sick, they may vomit, have a headache, sore throat or feel dizzy. These effects don’t usually last long. All surgery carries a risk of bleeding and infection.

As your child will now have direct access into the bloodstream he or she is at an increased risk of infection. The exit site can also become infected. However, good care of the exit site and weekly dressing changes when accessing the line will minimise the infection risk.

Only trained HD nurses can connect and disconnect your child to the Haemodialysis machine.

Once HD has finished the Haemodialysis Central Venous Catheter is flushed with saline and then filled with a medication called heparin or alteplase to prevent the line from clotting.

At the next session of HD, this medication is then removed prior to HD starting.

Ensure the yellow caps, parafilm and gauze stay in place when not having Haemodialysis, they help to prevent infection.

• Ensure the Catheter doesn’t get tangled up in clothing.
• Ensure the Catheter does not get pulled (your child can still do PE at school just ensure it is taped down).
• Ensure the clamps remained clamped

You will be given an emergency pack. This should be kept with your child at all times. You can have one for school/nursery. It will contain:

• Information sheet
• Tego bungs (yellow caps)
• Alco wipes
• Sterile gauze
• Spare dressings
• Blue clamps

The nurses will explain what do with the pack should you need to before you go home.

Clean the end of the line with an alcowipe and attach a new cap (both can be found in the emergency pack). Call Eagle Haemodialysis as your child will need intravenous (‘IV’ into the vein) antibiotics.

Secure it with tape, observing to see how far the line has been pulled. Call Eagle Haemodialysis to inform them of what has happened.

Place the blue clamps above where the cut/damage is to prevent any blood leakage, wrap an alco wipe around the damaged part of the line. Call Eagle Haemodialysis and arrange to come in for line repair and IV antibiotics.

Apply pressure to the exit site until bleeding has stopped. Cover the exit

site. Call Eagle Haemodialysis ward immediately.

Call Eagle Haemodialysis ward. A swab will need to be taken and your child may need antibiotics.

Call Eagle Haemodialysis for advice. Your child will need IV antibiotics.