ER nurse accessing Dialysis Cath in Emergency - page 2

by Huachuca

8,168 Views | 12 Comments

I am a nurse working in an emergency department. I had a patient last week that came in with a dialysis cath in her left chest wall. First of all let me say that I know to NEVER touch them. But here is the problem, the... Read More


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    I work in a smaller dialysis clinic inside a hospital. We only dialyze chronic "stable" patients as we do not have a nephrologist on-site. If there is a dialysis patient in our ER dept. and they needed to use the dialysis access (ONLY IF IMPOSSIBLE to get another site) they call to our unit and one of our hemo nurses would go to the ER to access the site. When they are finished with it, one of us would go over to flush, heparinize and cap-off the site. This doesn't happen frequently, but that is the best answer, if at all possible. We will also go over to draw bloodwork if unable to get from a venipuncture.
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    Quote from mo-mo
    Permcaths are usually heparinized with 5,000unit/ml or 10,000 unit /ml heparin. Sometimes there with be 'cathflo' or TPA in the line, or antibiotics, insead. Therefore, it's very important to withdraw a few cc's before flushing a dialysis catheter. Otherwise, its just a central line... BUt don't mess it up cuz, it is that pts life line, literally. It needs to be properly maintained. Especially AFTER use.

    IMO, every ER nurse and EMT should be trained on basic access and care of HD accesses. In a life threatening situation, better to use it and save a life, regardless of the old "nobody touches it but dialysis staff" addage.

    Bring it up to your leader.Following the death of this woman, he/she is bound to listen.

    Great points. In our hospitals I have helped them formulate policy on accessing the cathater so it is in line with how we provide care. we review it anually and certainly it is not accessed without the order of a Nephrologist and as a last resort.
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    IMO, every ER nurse and EMT should be trained on basic access and care of HD accesses. In a life threatening situation, better to use it and save a life, regardless of the old "nobody touches it but dialysis staff" addage.


    Agree wholeheartedly.

    We would often have to send a pt. to the ED and none of the nurses there would know how to pull the needle and/or even hold the site. One of our (usually "short") staff would always have to leave the clinic and go to the ER with the pt. merely to hold the site.

    Doesn't make sense.


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