Tunnelled Haemodialysis Catheter Insertion
Tunnelled Haemodialysis Catheter Insertion places a long-term central venous dialysis catheter in the internal jugular vein under image guidance — providing immediate, reliable haemodialysis access while a permanent AV fistula is maturing or as a bridge to long-term vascular access planning.
Overview
Tunnelled Haemodialysis Catheter Insertion places a large-bore dual-lumen silicone catheter through the internal jugular vein into the right atrium, tunnelled under the skin of the chest with a Dacron cuff that promotes tissue ingrowth and reduces infection risk. Unlike non-tunnelled central venous catheters, the tunnelled design with a subcutaneous cuff allows safe use for weeks to months while an AV fistula is being created and matured, or as a longer-term access solution when fistula creation is not possible. The catheter provides reliable high blood flow rates needed for effective haemodialysis immediately from the day of insertion.
Types of Long-Term Haemodialysis Access
Long-term haemodialysis access options are assessed individually for each patient by the nephrology and vascular access team, with AV fistula always being the preferred permanent option.
- Tunnelled Internal Jugular Catheter (right side preferred — direct route to right atrium)
- Tunnelled Femoral Haemodialysis Catheter (for patients with bilateral jugular or subclavian obstruction)
- Tunnelled Subclavian Catheter (avoided in pre-dialysis patients to protect arm veins for future fistula)
- Split-Tip Tunnelled Catheter (improved flow characteristics reducing recirculation)
- AV Graft (permanent surgical access option when native vessels are unsuitable for fistula)
Risk Factors for Difficult Haemodialysis Access
Certain patient factors make reliable long-term haemodialysis access challenging and increase the complexity of access surgery and maintenance.
- Previous central venous catheter insertions causing venous stenosis or thrombosis
- Morbid obesity making vascular access anatomically challenging
- Multiple previous access failures with depleted suitable vessels
- Coagulopathy increasing bleeding risk during access procedures
- Active bacteraemia contrainddicating tunnelled catheter insertion until infection is cleared
- Advanced peripheral vascular disease affecting both central and peripheral vessel quality
Haemodialysis Access Failure Symptoms
These symptoms indicate that the current haemodialysis access is failing and requires urgent assessment and intervention by the vascular access team.
- Inadequate blood flow rates during haemodialysis sessions reducing dialysis effectiveness
- Recurrent catheter tip thrombosis requiring repeated thrombolytic infusions
- Persistent exit site infection despite antibiotic treatment
- Catheter tunnel infection with erythema, tenderness, and discharge
- Bacteraemia associated with the haemodialysis catheter (catheter-related bloodstream infection)
- Arm swelling from central venous stenosis from previous catheter use
- Inability to aspirate adequate blood through the catheter at the start of dialysis
- Decreasing Kt/V (dialysis adequacy measure) despite normal session duration
Key Benefits
Discover the advantages of choosing our tunnelled haemodialysis catheter insertion services.
Immediate reliable haemodialysis access provided from the day of catheter insertion
Tunnelled design with Dacron cuff provides a more durable and lower-infection alternative to non-tunnelled catheters
Ultrasound guidance dramatically reduces access complications compared to blind technique
Fluoroscopic tip confirmation ensures optimal position for maximum dialysis blood flow
Day-case procedure with same-day discharge for stable dialysis patients
Clinical Features
The technology, techniques and clinical approach behind our tunnelled haemodialysis catheter insertion.
Real-time ultrasound guidance for venepuncture eliminates blind landmark technique complications
Fluoroscopic tip positioning confirms cavoatrial junction placement for maximum flow
Dacron cuff positioned 2 to 3 cm from exit site reducing catheter-related infection risk
Post-procedure chest X-ray confirms catheter position and excludes pneumothorax
Haemodialysis can typically be performed through the catheter on the day of insertion
Preparation Instructions
After Tunnelled Catheter Insertion, protect the exit site dressing and keep it clean and dry between dialysis sessions according to your dialysis unit's specific dressing protocol. Never use the catheter for any purpose other than haemodialysis — blood draws, medication infusions, and IV fluids through a haemodialysis catheter significantly increase infection risk. Contact your dialysis unit or nephrologist immediately for fever, chills occurring during dialysis, exit site redness or discharge, or inability to use the catheter at the start of a session.
The Procedure
Step-by-step guide to what you can expect during your tunnelled haemodialysis catheter insertion procedure.
Vein Assessment and Access Planning
Bilateral neck and chest duplex ultrasound and a recent chest X-ray confirm that the right internal jugular vein is patent and the ideal access for tunnelled catheter insertion before the procedure begins.
Ultrasound Guided Venepuncture
The right internal jugular vein is punctured under real-time ultrasound guidance, confirming venous (not arterial) access before a guide wire is advanced under fluoroscopic visualisation to the right atrium.
Subcutaneous Tunnel Creation
A subcutaneous tunnel is created from the planned exit site on the anterior chest wall up to the venous entry point, and the catheter is passed through the tunnel ensuring the Dacron cuff sits subcutaneously 2 to 3 cm from the exit site.
Fluoroscopic Catheter Tip Positioning
The catheter tip is advanced over the guide wire under fluoroscopic guidance to the cavoatrial junction or right atrium — the optimal position for maximum blood flow during haemodialysis sessions.
Dialysis Adequacy Flow Testing
Both lumen of the catheter are aspirated and flushed confirming free blood aspiration and adequate flow before the guide wire is removed and the catheter is locked with heparin or citrate solution.
Chest X-Ray and Discharge
A post-procedure chest X-ray confirms catheter position and excludes pneumothorax before the dressing is secured. Dialysis can be performed through the catheter on the same day in most cases.
What to Expect
Tunnelled Haemodialysis Catheter Insertion is performed under ultrasound guidance and fluoroscopy with local anaesthesia and sedation, taking 45 to 60 minutes. The right internal jugular vein is accessed under real-time ultrasound, the catheter is tunnelled subcutaneously from the exit site on the anterior chest to the venous entry point, and the tip position in the right atrium is confirmed fluoroscopically before the catheter is secured and dressed. Haemodialysis can typically be performed through the catheter on the same day.
Frequently Asked Questions
Common questions about tunnelled haemodialysis catheter insertion.
Related Services
Explore other services in our Nephrology department.
Brain Tumour Complex
Haemodialysis Access Surgery
Renal Biopsy
Ready to Get Started?
Schedule your consultation today and take the first step towards better health.