[Huachuca]

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 patient was most likely septic, 80 some years old. We needed to get a fluid bolus into her. there was absolutely no access....even the doc couldn't get an EJ started. They were just going for a central line when the little old lady died. So my question, would it ever be acceptable to access the dialysis cath and if so ..HOW to do it with the supplies on hand in the ER.

thanks

Huachuca

[psalm]

At our hospital we need a doctor's order to use the permacath for fluids. I work on the floor and sometimes when there's no other route, the doc will give an order, but I don't think it is protocol. There are orders to follow concerning when to use heparin and to withdraw waste before starting fluids.

[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.

[Huachuca]

Thanks for those words of advise. I think I will go to my nurse educator with this because it would be great to be educated about it BEFORE you have to figure it out the hard way.

Huachuca

[steelcityrn]

Having just had a dialysis patient in homecare who almost lost her only arm that can have a dialysis catherter, I agree that protocol has to be maintained, this is their lifeline. This poor woman went through he** with hers clotting off and the need for a fem catheter (temporary use only). She wanted to give up and die, but after talking things over with her, she will now look into having all her pre-testing to be placed onto the kidney transplant list.

[diabo]

Great post, MO MO. Most important points: withdraw 3-5cc and discard. Best to flush with 8cc or so of NS then hook up the fluids. When finished run the fluids at KVO to the port. That way you don't have to draw up a flush after each push med. just open the line for a second to flush. The port can be properly stored at a later time. Just make sure the doc writes it clearly so the nurses in the unit the patient gets transferred to don't just cut the fluid off and clot her lifeline.

[nursedandy]

It is also important to note that when using the dialysis pt's catheter in infusing TPN it needs to be flush 2 times per day to avoid protein build up which will cause the catheter to clog . Also not advisable to use the catheter with infusion with flow rate of 10cc/hr and below.

[CVICURN2003]

Originally Posted by Huachuca

Thanks for those words of advise. I think I will go to my nurse educator with this because it would be great to be educated about it BEFORE you have to figure it out the hard way.

Huachuca

We have to have a MD order and it be an EMERGENCY. I have used Quinton's often (We . If you clotted off her cath (which would be BAD) becasue you "couldn't use the perma cath" and she die sbecasue she needed a life saving med (she did), the fact that her perma cath is still intact is great....except she is DEAD. So, this is not a flame toward you at all, where was the MD to tell you to use the permacath (after wasted and flushed) for IV access. So, I would definatly tell my educator or nurse leader to make sure there are protocols in place for those situations.

[Hellllllo Nurse]

Originally Posted by CVICURN2003

We have to have a MD order and it be an EMERGENCY. I have used Quinton's often (We . If you clotted off her cath (which would be BAD) becasue you "couldn't use the perma cath" and she die sbecasue she needed a life saving med (she did), the fact that her perma cath is still intact is great....except she is DEAD. So, this is not a flame toward you at all, where was the MD to tell you to use the permacath (after wasted and flushed) for IV access. So, I would definatly tell my educator or nurse leader to make sure there are protocols in place for those situations.

I agree. What good is an untouched dialysis access if the pt is dead?

It's like the old saying "The operation was a success, but the pt died."

If you want to make an omlet, you gotta break a few eggs.

[Migrant_Renal_RN]

As a dialysis nurse of 17 years, having done acutes and chronics...and the wife of a dialysis patient....I encourage you to use another site if possible, however, with dialysis patients that is not always the case!! It much better to use a site that is available in an emergency situation, and ask forgiveness later, ie.call the acute nurses or the dialysis clinic to report your action and ask the best way to resecure the site to maintain patency!! A dialysis access is not going to do a dead patient any good, and sometimes, fumbling around trying to get an alternative IV line in may bugger up future dialysis access sites.