[keypit2yrself]

Hi I'm New to this forum. Also From the GREAT State of Texas. I have a question to post. Is it every OK for a patient w/ a temporary hemodialysis catheter in the femoral vein to ambulate????? Many of my colleagues say no, but the physician has written an order for ambulate as tolerated. What say you all you nephrology nurse experts out there?

[Tweety]

I don't think there are any contraindications to ambulation with a femerol cath, but I'll defer to the expertise of my fellow collegues on the General Forum where I moved your question.

Good luck and Welcome!

[traumaRUs]

No - that is fine as long as you are careful. We have folks nowadays that have thigh grafts that live in the community.

[km5v6r]

Originally Posted by keypit2yrself

Hi I'm New to this forum. Also From the GREAT State of Texas. I have a question to post. Is it every OK for a patient w/ a temporary hemodialysis catheter in the femoral vein to ambulate????? Many of my colleagues say no, but the physician has written an order for ambulate as tolerated. What say you all you nephrology nurse experts out there?

NO,NO,NO,NO...Every hospital I have worked in, every dialysis company I have worked for has a policy AGAINST ambulating with a temporary femoral dialysis line. Most places require the pt to be flat in bed with the leg extended while the line is in place. They don't even want the pt sitting up in bed. The catheter used for a temporary dialysis line is very stiff. Once that catheter is bent from sitting the likehood of it working is minimal. The resulting kink is usually pretty premanent. The risk also exist of the catheter infiltrating the back wall of the femoral vein and causing a retroperitoneal bleed. Lines are placed in the femoral vein are not the placement of choice. Did the Nephrologist write this order for ambulation or did some other doc? General rule of thumb; if it has to do with a dialysis pt run it by the Nephrologist or the dialysis nurse first. Don't trust residents on this either.

[km5v6r]

Originally Posted by traumaRUs

No - that is fine as long as you are careful. We have folks nowadays that have thigh grafts that live in the community.

But a thigh graft is a totally different situation. A perm cath is a totally different situation too. A graft is the hollow tube with one end sewen to the artery and one sewen to the vein. The tube is then tunneled under the skin. Nothing hanging out. Nothing to get kinked. Nothing to jam through the back wall of the vein. A perm cath is also made of a different material then a temporary cath. Temp cath or Quinton's are much stiffer to allow placement at the bedside with minimal difficulty and without fluro. We had temp caths and perm caths for teaching purposes. It is possible to use a temp cath to stake up plants in the garden. They are not flexible or soft.

[traumaRUs]

Because I'm new to dialysis, I wanted to ensure what that I'm giving correct advice. I looked at the Bard Access Site:

http://www.bardaccess.com/

And from this site, as long as they are using the softer silicone catheters, ambulation can be done, though they do agree it is difficult. I do have two patients with temp femoral lines that due to vascular disease this is the only site for a catheter. They both do walk and in fact one works full-time. These are Perma-Caths so are made of softer material.

I know the temp accesses (I used to work in the ER where we used very stiff, very short, large bore central lines for emergent dialysis due to ingestion) are much more difficult to work with.

[TazziRN]

I knew a nurse who was on outpt dialysis with a femoral cath. She had to be careful but she was not confined to bed. She drove and got out of the house, just had to be careful.

[km5v6r]

Originally Posted by traumaRUs

Because I'm new to dialysis, I wanted to ensure what that I'm giving correct advice. I looked at the Bard Access Site:

http://www.bardaccess.com/

And from this site, as long as they are using the softer silicone catheters, ambulation can be done, though they do agree it is difficult. I do have two patients with temp femoral lines that due to vascular disease this is the only site for a catheter. They both do walk and in fact one works full-time. These are Perma-Caths so are made of softer material.

I know the temp accesses (I used to work in the ER where we used very stiff, very short, large bore central lines for emergent dialysis due to ingestion) are much more difficult to work with.

This site showed a tunneled perm cath. Again made of different material then a temporary cath. Instead of using the terms temporary and perm cath instead use tunneled and non-tunneled. A tunneled femoral cath is made of much softer material and the pt can be up walking with one. In this area it is the only type of catheter you will see outside a hospital. The type of catheter that you used to place in the ER is a non-tunneled catheter. These are almost exclusively used in the hospital while waiting for a tunneled catheter to be placed. On rare occasion the docs will discharge a pt with a non-tunneled temporary catheter placed in the IJ or SC. It is always over the protest of the dialysis nurse. The pt is at high risk for infection, bleeding and air embolism if something happens to that catheter at home. Nothing but the sutures are holding it in place. These stiff, short catheters; generally refered to as a Quinton; should not be bent or used to walk with. Quinton is a brand of catheter but the name is used by many to refer to a type of temporary dialysis catheter. Much like Kleenex is a brand name that has passed into general usage to refer facial tissuse.

[km5v6r]

Originally Posted by TazziRN

I knew a nurse who was on outpt dialysis with a femoral cath. She had to be careful but she was not confined to bed. She drove and got out of the house, just had to be careful.

And I am sure she had a tunneled or perm cath placed in the femoral vein. Again these are made of a very soft silicone and are made for flexibility with a cuff tunneled under the skin to help secure the catheter in place. Similar to a Hickman or Groshong catheter used for chemo. A non-tunnel hemo line is closer to the venous sheaths used for a heart cath.

[keypit2yrself]

Thank you ALL so much. I do know this patient had a permacath. She had been on HD for a long time. She was on our telemetry unit for cardiac issues unrelated to the catheter. It sounds as if not all dialysis catheters are created equal and this discussion has shed some new light on the situation.