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Discussion

dialaysis access

A new surgeon in our area insists the best access for a 600 lb frequent flier that is currently on dialysis is a regular tunneled catheter (i.e. Hickman) that can be used for everything, including dialysis. I replied that I had never heard of using a regular tunneled catheter for dialysis. He replied that he does it all the time but refused to elaborate. Is this a new thing? old thing? Am I uninformed, or is the surgeon wack? ( I am not a dialysis nurse so I don't even pretend to know much about it, but I am an IV specialist, have worked on t he east coast and in the west and not o nce in thirty years have I come aacross someone using a regular CVL for dialysis.) Please someone clue me in.

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It is not uncommon at all for a dialysis patient to use a double lumen tunneled catheter for dialysis. Ideally, we would like to eventually progress to using a fistula or graft but there are some patients, where, for one reason or another, those types of accesses are not appropriate and the patient become catheter dependent. I could see this happening in a 600 lb pt like you describe. The pts do face increased risk of infection and catheters that become clotted, and many patients have to have catheters replaced repeatedly due to these complications. But, we do see these catheter dependent patients all the time.

we do have patients on tempory catheter access for hemodialysis (quinton cath) and clients on perm-cath.

Some are with fistula or graft.

Thank you.

  • Author

OK, I know about Qentin, Tessio, and Permacaths. THese are tunneled, cuffed catheters that are made for dialysis. They have larger lumens and staggered end ports. I'm referring to a REGULAR tunneled catheter, those that are routinely used as CVL's. The surgeon insisted he used THOSE regularly, for dialysis.

A Hickman is used for :

  • Drawing blood
  • Chemotherapy
  • IV fluids
  • Blood transfusions
  • IV nutrition

I have experienced many surgeons call our large bore dialysis catheters "Hickman's", because they are too a tunneled catheter.

Just like a lot of floor staff called all dialysis catheters "tesio's" when they first came out and they were not truly a tesio catheter.

Same thing when you hear an older nurse call a fistula or graft a "shunt".

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