Tunnelled dialysis catheter
A large-bore chest line that is the patient's dialysis lifeline. Fever = assume line infection until proven otherwise - and it is not for your routine bloods or drugs.
Also called: dialysis line, tunnelled dialysis catheter, TDC, permcath, Permcath, neckline
What it is
A tunnelled dialysis catheter is a large-bore, usually twin-lumen central line, tunnelled under the chest skin and entering a central vein, used for haemodialysis when a fistula or graft is not available or not yet working. Between dialysis sessions each lumen is filled ('locked') with heparin or citrate, so it is not a line you draw from casually.
Its dominant complication is infection - the UKKA guideline states that Tunnelled dialysis catheter infections are a significant cause of morbidity and mortality
in haemodialysis patients - so in a febrile dialysis-catheter patient, line infection is the default assumption. The other problems are occlusion and bleeding/dislodgement. Adults; paediatric dialysis access is managed by paediatric nephrology.
How to recognise it
- A large-bore twin-lumen catheter exiting the chest wall (or neck), with two clamped lumens, often labelled arterial and venous, in a patient on haemodialysis.
- A patient who attends a dialysis unit and whose line is normally used only for dialysis, locked between sessions.
- Signs of infection at the exit site or tunnel, or systemic features of bacteraemia (fever, rigors, often during or after dialysis).
What it gets confused with
A Hickman is a smaller general-purpose tunnelled line for chemo or TPN; a dialysis catheter is large-bore, for dialysis only, and locked with heparin/citrate. Do not treat a dialysis catheter as a general-use line.
What goes wrong
Catheter-related bloodstream infection
Fever or rigors in a dialysis-catheter patient, classically around a dialysis session, with or without exit-site signs. The default diagnosis.
Red flag
Take blood cultures before antibiotics - the UKKA guidance is that blood cultures should therefore be taken before treatment of any catheter infection
- and start empirical antibiotics per renal-unit policy (local policies typically cover Staphylococcus, including MRSA where prevalent). Involve the renal team on line salvage versus removal.
Exit-site or tunnel infection
Exit-site redness and discharge, or tenderness and erythema along the tunnel.
Red flag
The UKKA guidance notes Exit site infections without bacteraemia are usually treated systemically for 1-2 weeks
, whereas tunnel involvement or systemic infection more often needs the line removed. Culture, treat, refer.
Blockage or poor flow
The line will not aspirate or gives poor dialysis flow - thrombus or fibrin sheath.
Red flag
This is a renal-unit problem (thrombolytic lock, line exchange). Do not force it; refer.
Bleeding or dislodgement
Bleeding from the exit site, or a line that has partly pulled out.
Red flag
Apply pressure; a large-bore central line that is dislodged or cut risks significant bleeding and air embolism - clamp it and refer urgently.
The first ten minutes
- Assume line infection in a febrile dialysis-catheter patient and take blood cultures before antibiotics, then start empirical cover per renal-unit policy.
- Do not use the dialysis catheter for routine bloods or drugs. It is the lifeline, locked with heparin/citrate, and accessing it needs strict asepsis by someone competent. Use peripheral access (not the fistula arm) for your samples and drugs.
- Treat sepsis on its merits and look for other sources too - a dialysis patient gets ordinary infections.
- For bleeding or dislodgement, apply pressure, clamp the line, and refer urgently - air embolism and haemorrhage are the risks.
- Call the renal unit about the catheter, the cultures, and the decision to lock, salvage or remove.
Do not
Who owns it
The renal unit (and interventional radiology for line problems). Tell them the catheter type, the exit-site and systemic findings, the cultures, whether it flows, and the dialysis schedule.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Dialysis patients know their unit and schedule and that the line is for dialysis only. Many carry a renal-unit contact card.
Scope of this page
This page covers recognising a tunnelled dialysis catheter and the first ED steps: assume and work up line infection, protect and do not misuse the line, manage bleeding/dislodgement, and refer to the renal unit. It does not cover line locking, exchange, thrombolysis or the salvage-versus-removal decision, which are the renal unit's. Adults; paediatric dialysis access is managed by paediatric nephrology.