Do RNs declot temporary hemodialysis catheters?

  1. 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
    •  
  2. 18 Comments

  3. by   TELEpathicRN
    As an Acute RN, we use TPA 2mg and instill it in the catheter. Pull it out the next treatment and see if it worked. Your hospital should have a policy on this if they are using thrombolytics. Do you work dialysis?
  4. by   ageless
    We use ativase 2 mg (with a dilutent to fill volume) in each limb of the catheter. We leave it in 20-40 minutes and then start the treatment. Sometimes it may have to be repeated. Activase is used in our chronic and acute centers.
  5. by   frankie
    Hi ageless and telepathic - frankie here - I work in an out patient infusion center. I have been asked to declot hemodialysis catheters, as they have been being sent to ONE DAY SURGERY - can you believe that - the ED nor inpatient IV team will declot the catheters. I am well versed in the venous side, but I have only flushed the arterial side - never declotted it. So, I know with the correct inservice, competency , etc... It is within my scope of practice, but I wanted input from other RNs who do this daily. thanks a bunch - frankie
  6. by   New CCU RN
    I am not a dialysis RN..... very interesting area. Anyhow, I know I have had patients in the unit that the Dialysis RN did come and declot the catheter if it clotted over. They had to call the MD first....just what I have seen...don't know the inside scoop on it!
  7. by   patadney
    We can only instill medication to cause declotting. I have seena device like a very small bottle brush that is supposed to be used for stripping the inside of the catheters,but I would not think I would want that responsibilty. Dialysis catheters are large and the tip pf them is inside the right atrium of the heart if they are properly placed. I will allow the surgeons to do that.One way to decrease the likelihood of clotting is for the pt to be placed on coumadin-very small doses seem to help keep them open. Keeping these catheters open is very important as they are the pt lifeline,without dialysis they will die.
  8. by   jnette
    Here too, Ageless!

    Just did one yesterday. We use Urokinase, same procedure as yours. Leave in 30 minutes, start tx. Repeat if necc'y. With our problem caths, we also flush the dialyzer with100 ml saline every half hour, and add the total flush volumes into their goal before tx. begins. This is mailnly to keep the dialyzer from clotting, not the cath itself. But as you well know, caths seem to bog down a dialyzer. Do you all have heparin pumps on your machines? We use ours on nearly half our patients. Along with the bolus beforehand. They really work well.

    Nice to see this dailysis forum taking off. Now.. about COMPLIANCE.... !!!! That wil be a whole NUTHER discussion ! Would lile to see how everyone deals with compliance issues, and what works best for them ! Not COMING to tx., but with the diet/fluids issue ! We have some REAL problem children... only a few, but boy-oh-boy !!! Any suggestions that have worked for you? Shoot 'em on my way !
  9. by   jnette
    sorry.. need to preview my posts before I hit the "send"...hate spelling errors ! I get to typing too quickly..

    ok... what I meant by not COMING was that all our patients show up faithfully, that's NOT a problem.. but we do have a handful that we simply cannot get to do for themselves regarding their health in the fluids area especially.

    OF course here in the "pinto beans cornbread, and 'taters part of the country, we keep a lot of high phosphorous, too !
  10. by   caroladybelle
    I have been asked to do it, as a travelor but always ask for each facilities policy before attempting. Is difficult to know the dwell capacity of all different caths (does anyone know a link with these references)
  11. by   Allaroundnurse
    Most catheters have the capacity on the clamps. We have started using cathflo activase and found that it works better if you can leave it in overnite. Any other declots we send to the surgeon or to Interventional Radiology. Plavix 75mg qd also works good.

    As far as your problem children: I have found that they respond better to having them weigh several times a day (I make them a chart with Kg converted to #) and my 5-6K wt gainers are now down to 3-4K over the Weekend. If all else fails instead of shooting ideas......
  12. by   RNonsense
    Our renal unit RN's do it...
  13. by   ValWai
    How about completely blocked catheter? Sometime the clotting is so bad that nothing can go in or out. It's impossible to instill anti-coagulant into the catheter without dislodging the clot. I used to draw the catheter until it collapses with a 20 syringe. Then I clamp the catheter when it's flat and fill the catheter with diluted heparin when I release the clamp. Though I know that heparin prevents clot formation instead of dissolving them. But it works and it will not dislodge the clot into patient's cirulation. The only thing that worries me is whether the suction I
    exert will damage the vessel wall. Do you think it's safe?
  14. by   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??

close