Clave not Cap on HD Catheter

[awheat]

Call the hospital or not? Patient came in with a subclavian catheter to use while a new graft was healing in her arm. On the end of the 2 ports were claves, not caps. I used to work at the hospital she had her day surgery at (for the graft) and know these claves are what they use on central catheters (not dialysis accesses), PICCs and IJs, that the floor nurse can hook the IV lines up to or give IV meds. All is well in her case, surgery went well, she came to our clinic for HD and we removed the claves and replaced them with caps when we were done.

My concern is this - in my time at the hospital, I never saw an HD catheter w/ claves on the end (there was the occasional pigtail w/ a clave, but not the arterial or venous ports). If something had happened and the client was admitted to the floor I can see the possibility that a nurse might inadvertently use the access as a regular IV access. I say this because this facility is notorious for hiring new nurses and cannot keep experienced ones past their contract dates. Also, shift report is only as complete as the 2 nurses involved care to be, and a lot of nurses are too concerned with going home to give a good report.

Should we contact the hospital to let them know that there is a potential here for a problem if they are going to do this, or not worry as maybe it was a one-time issue?

[jb2u, ASN, RN]

We always put claves on our HD catheters. I work in a 581 bed hospital. We have a very busy dialysis unit and never use caps. I wished the floor did not use our catheters, but unfortunately they do. We are trying to change that culture now. We are also going to the TEGO connectors.

[Guttercat, ASN, RN]

My concern is this - in my time at the hospital, I never saw an HD catheter w/ claves on the end (there was the occasional pigtail w/ a clave, but not the arterial or venous ports). If something had happened and the client was admitted to the floor I can see the possibility that a nurse might inadvertently use the access as a regular IV access. I say this because this facility is notorious for hiring new nurses and cannot keep experienced ones past their contract dates. Also, shift report is only as complete as the 2 nurses involved care to be, and a lot of nurses are too concerned with going home to give a good report.

Should we contact the hospital to let them know that there is a potential here for a problem if they are going to do this, or not worry as maybe it was a one-time issue?

We had an incident where a floor RN used the SC dialysis cath for routine IV meds, and without using proper technique when opening the lines.

Our policy is that dialysis catheters are not to be accessed unless it is needed for emergent use and ordered by a nephrologist i.e., the pt. needs emergent meds and has no other viable access options without a cut-down, or equally rarely, when a line for CVP readings is needed. And even then, the staff performing the procedure must follow protocol in accessing the line(s).

So, we implemented the use of red stickers we wrap on the ends of the catheter limbs that read "Dialysis only. Do not use."

Even Diagnostic Imaging department knows to put these stickers on when they have finished with a line insertion.

These stickers are easily obtained for any hospital, and save all departments from misinformation/guessing.

[acutedialysis]

Maybe try asking the patient? Otherwise I would call the hospital and ask them. They will most likely deny using the catheter, but at least you can documnet the information and the conservation. That way, if , God forbid, the catheter ends up infected, you have some documentation on your end.

We also use the TEGO connectors and love them. (With Swab caps on the end of them).