Tunnelled dialysis catheter insertion

A tunnelled dialysis catheter is a soft double-lumen tube placed in a large vein, most often the right internal jugular vein, with its tip positioned at the entrance of the heart. Its external part exits on the upper chest after running a few centimetres under the skin (the tunnel). This tunnel and a small cuff that becomes anchored in the tissues hold it in place and limit the risk of infection. Insertion is done under local anaesthesia, sometimes with light sedation. The vein is located and punctured under ultrasound, and the catheter position is checked by fluoroscopy. The catheter can be used for dialysis straight away. It is indicated when dialysis must start without an available fistula, while waiting for a fistula to mature, when the arm veins no longer allow a fistula, or when the heart condition makes a fistula inadvisable. In principle it remains a temporary solution, as a fistula provides better-quality dialysis with fewer infections. At Clinique Pasteur Tunis, insertion is carried out in the operating theatre or catheterisation laboratory, under ultrasound and X-ray guidance, in liaison with the nephrology and dialysis team.