Do RNs declot temporary hemodialysis catheters?

[frankie]

Question for RNs - If it is within the scope of nursing practice in your state, do RNs declot hemodialysis catheters (permacaths)? and If yes, where could I find procedure for declotting the arterial side? Many Thanks - frankie

[TELEpathicRN]

Should be pretty safe, have had MD's request us to do this. If the catheter is comepletely clotted, I do what you so, sometimes just with 10 cc syringe, wait until the cath is collapsed, clamp, and then instill the TPA or cathflow activase. Alot of the caths that we instill the activase in are just arterial ports that are sluggish and won't work on the machine ( pillow collapsing, sucking, etc..). We have a few MD's that just can't stand the fact that you have to reverse a catheter!! I don't like to do it, but you do what you gotta do!! One of the docs told me that you aren't doing the pt any good, all you are doing is recirculating the pts blood. Well.... how come when I have had to reverse the lines during an emergency treatment, that the pts K+ level came down from like 6.8 to 5.0 when it was redrawn??

[Robbilin]

We often times will use the 2mg of Activase and put it in whatever port is either clotted off or very sluggish, leave it in until the next treatment, then withdraw it. If the port is completely clotted, we will put it in and then wait 20-30 minutes, then attempt aspiration. If it doesn't work still, we wait another 30 minutes, etc. Hope this helps!

[Ruby Vee, BSN]

We use 2 mg. of tPA as well -- instilled into each side of the catheeter and left in until the next treatment. A few times, the catheter has been too sluggish to START dialysis, and then we tPA it for 30 - 60 minutes. It usually works pretty well. Only once it's NOT worked, and in that case the Renal team came and changed out the catheter -- we are talking about TEMPORARY catheters, aren't we?

[ageless]

Rarely have I declotted a temporary cath....I was referring to perm caths, but the procedure would be the same.

[nursefiggy]

As an LPN I can use activase also. If we have a cath that we can't seem to get over 200 blod flow we will let it dwell until next tx. If we have one that won't work at all ot not very well without constant alarming, we will let it dwell for 30 minutes then pull it out and try again.

[nursefiggy]

TELE, we have many pts that have permanent catheters that run reversed every tx. Most of their monthly URRs are fine.

[babyboomerRN, RN]

We use cathflo in our unit,2mg/2ml and it works really well. Let it dwell for approx 30 min. withdraw and the treatment runs well.