Accessing chest catheter

Specialties Urology

Updated:   Published

Specializes in ER, OR, Cardiac ICU.

Hey everyone, ER nurse crashing your boards...

Need help here. We had a dialysis patient present the other night in our ER in a crappy rhythm but pretty stable. One of the other nurses thought nothing of accessing the blue port on her catheter to push meds while I harkened back to the days that the nephro would scream to high Heaven if we even looked at it.

What's the conventional thinking about accessing the blue port in areas outside of dialysis? What are considerations that need to be taken in doing so? Thanks!

1
Up Vote Up Vote ×
Specializes in cardiac/critical care/ informatics.

We usually don't touch the dialysis cath either, unless it has the 3rd port on it.

1
Up Vote Up Vote ×
Specializes in Emergency, Trauma.

We don't touch dialysis access in the ER unless the patient is coding.

1
Up Vote Up Vote ×
Specializes in Phys Rehab and Dialysis.

Only in very serious instances,,codes mainly are they touched by any but hemo.

That said,,you have to be very clean about opening it and pull at least 2cc of blood from it before using d/t the heparing dwelling in it,

After using just make sure it is flushed with nss and relocked with the proper heparin soln (depends on the facility)

1
Up Vote Up Vote ×
Specializes in dialysis (mostly) some L&D, Rehab/LTC.

That's their lifeline...leave it alone!:nono:

1
Up Vote Up Vote ×
Specializes in ER, Renal Dialysis.

Those catheter are 'locked' with pure heparin (ranging from 6000-10000 IU, my practice here - depending on type) to prevent the line from clotting.

Imagine pushing that much into the body!!! People unfamiliar with this have not realized the presence and flush away. In any case, pull out the heparin before using the line. Though not really recommended since that line is so fragile.

1
Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

I'm an APN in nephrology and we really, really, stronglyh, very strongly don't want others using the permacath. As someone said - its our pts lifeline. Only during a code or bonafide life or death emergency is it okay and even then its not "okay."

1
Up Vote Up Vote ×
Specializes in Acute Hemodialysis, Cardiac, ICU, OR.

The only people aside from HD staff allowed to access the ports in our hospital are ICU nurses. The heparin lock issue is very important -- if that line clots because someone doesn't know what they're doing, we can't dialyze them. The Nephrologists would have a few choice words, to be sure.

1
Up Vote Up Vote ×
Specializes in Telemetry/Hemodialysis.

Before working in dialysis I was a Travel Telemetry nurse.:redbeathe I remember coding a dialysis pt with a blood sugar of 26 or something crazy low.:bugeyes:

The IV was clotted and none of us were able to place a peripheral for before she started to arrest.:banghead:

We could have easily prevented that code if one of us was trained to access the dialysis cath. Maybe the charge or supervisor? :nurse:

ER nurse! of course they should be trained to access the pts "Life Line" They are saving their life...:twocents:

1
Up Vote Up Vote ×
+ Add a Comment