IJ catheter for Dialysis - page 2

by kstec

I'm an LPN, so I do not know a whole lot about Picc lines, central lines, etc. I'm only familiar with you basic INT. In my state we don't even get to learn about them, much less do anything with them. Well my question is, I... Read More

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    Quote from mpccrn
    ummm some of the above information is correct, some not so accurate. i left ICU and was a dialysis nurse for about 5 years.
    First, IJ's are a central line like PICC's, subclavians or femoral lines. yes there are 2 ports marked V and A, but it's in the same vessel. The V and A are more likely indicative of the where the other end of the catheter lumen lie in the vessel itself, distal or proximal. It is used to hook the patient to the machine. 'A' being the line used to withdraw the blood from the patient to feed the machine and 'V' used for its return.

    2nd: the lines are heparinized with a more concentrated heparin solution to ensure their patency. Dialysis nurses and docs are EXTREMELY territorial when it comes to their lines. we didn't want people messing with them because they were essentially the patient's lifeline and their only means of dialysis access. Nephrologists don't place lines and must rely on someone else to put them in. that's a pain in the butt and slows us down. a 4 hours treatment is really about 6 hours to the nurse doing it cuz they have to warm up the machine, test it and then disinfected it after the treatment. better no one uses our line.

    3rd: a dialysis line CAN be used for med administration, provided you pull the heparin out of it, 10 cc waste is usual, and block it again with heparn when done. we'd prefer if you don't use it for routine med administration but in an emergency or no other options availabe it is a viable route. refer to #2.

    4th: a fistula may or may not be accessible depending on it's blood flow and maturity. it's usual to place a line in as the fistula develops and matures. it's not uncommon to try sticking it and see what happens. sometimes it collapses, sometimes it's flow is not enough to sustain the machine, sometimes you pull from it and return to the line. using it will eventually make it stronger.

    5th: your suggestion of an alternative route and opening a discussion with the doc should in no way make you feel like an idiot! i'd worry more if you tried to fake it. docs and your co-workers will appreciate your conscientiousness. it show you were thinking and your confidence in your knowledge base to ask in the first place. you were your patient's advocate. good job!

    6th: nursing is an ongoing learning process. when you are unwilling to continue leaning, it's time to get out!

    hope this helps. :heartbeat

    Well done! I couldn't have said it better myself!

    One thing to add... Sometimes these IJ temporary dialysis catheters have a med port attached to them. There will be the 2 lines (with a red and a blue cap) then a smaller 3rd line that is skinnier like a central line. In the hospital we use the small line for meds.

    Now that is ONLY in the temporary IJ dialysis catheters. NOT in the chest wall perm catheters. I've never seen a perm cath that had a med port. The perm cath usually sits on the left or right chest area, where the temp IJ cath is up in the neck. I'm not sure which one the OP is talking about.

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    i realize this thread was created a long while ago but it is as fresh to me as the conversation is to me and i would appreciate seasoned nurses in the mix to give their inputs. I've been an rn for less than 2yrs and an incident occured at my institution with regards to the usage of a jugular catheter. my patient an ESRD pt went to the OR for the insertion of a new catheter and Av graft, which became a complicated procedure as she bled intensely while still in OT to the point that she bacame quite unstable. Anyways she was taken back in the OT where an exploratory was done and she got drain inserted her hb dropped severely that she had to get ffps and prbcs. when i went to pick her up from the OR, i received her with q unit of PRBC infusing via her newly inserted jugular catheter, i took he backon the unit and recommenced the blood via the access, and on completion i flushed same with saline, i handed over and left for the day while the patient was still receiving the saline flush infusion. on arrival the next day this pt was in severe pain, she complained of pain to her chest area underneath her left breast, assuming it was the impact of the jugular cathether, i assessed her pain medication and realised she got nothing for pain since return from OT, so i chose to give her the prescribed morphine, but as her piv was down and the jugular cathether was still uncapped with aheplock conector still attached i decided to give it via that port (in my institution only med interns put up iv catheters, rns only put them up in emergency situations). this i did with the knowledege that pts receive medications via same during codes or emergency situation and because the port was stil saline locked following the administration of blood from the previous day i didn't think it was contraindicated. unfortunately my pt's pain was not relieved and eventually a CT spiral with contrast was done (the contrast was also passed thru thesame port) which revealed a pneumothorax (the pt had a puncture wound, which according the the surgeons was a very minute one, that will seal on it's own). i discussed this with my coleeagues who are all seniors to me, and explained to them not until we got to radiology department did i wonder if we the A line was the right line to use as opposed to the V line but then, in the same breathe i recalled that UACs are used in babies fro very strong medicines, so i brushed it off with the intent to research more on it (that's my favourite thing and it's howm am on this page today). but to my dismay the next day my colleagues were very much concerned and believed i should write an incident report because that wasn't the right action to have taken because "the jugular cathether isn't a central line" disturbed, i explained i know it wasn't the best access but i went ahead to use it becos i have used it before in a code situation. well long story short i spoke to my area sister and the consultant on that team who like many others have said indicated that the jugular access wasn't the best port to have used but then it's use was restricted for fear of clotting, but in general they don't think i should be worried about it. My concern now is, i was very shocked, because the talk became the fact that i used an arterial line to administer blood, but today am most joyous to read here that not only is the line a "no go area" for floor nurses but it's also a catheter whose tip is single and positioned in the right atrium just like other cvc. Am relieved to a great level and am glad i've learnd another thing cos now i understand why the dialysis nurses protect that line and the anatomy of this line. my colleagues really made me believe the administration of morphine via that port was the cause of the pt's weakness, which in fairness was never an issue afte the pt was encouraged to exercise and utilise her muscles. So , experienced nurses thank you for always sharing your 5cents on this site and providing new nurses lyk myself the opprtunity to advance our career through your knowledge. i know i could have done otherwise like my colleague who started this thread but at thesame time i think it was a huge learning proces for me.
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    Also worth mentioning that these catheters in the IJ are temporary ( as opposed to permacaths which are tunneled) and are held in place by stitches. I would be very concerned as to placement on a catheter without sutures to hold it in place. DO NOT MANIPULATE A CATHETER WITHOUT SUTURES. Very easy to displace. Back when dinosaurs roamed the earth they were heparin locked with up to 7,500 units of heparin. The trend now is no heparin with some kind of cap, we use TEGO brand, that keeps the line from clotting and only use saline as a lock.