Dialysis Subclavian line antibiotics.

Simonesays, BSN, RN · Mar 1, 2016

Yep! Agree with what others have said. We were only allowed to access them in emergencies (and in a couple of rare non-emergency cases) for the same reasons listed above. Definitely check your policies! Also, quite a few of the patients at our hospital seem to be capped with a sodium-citrate solution (fewer CDIs I believe) which we don't stock on the wards. It's also a slightly different procedure to access/cap an HD line.

This is not to say that you can't run antibiotics through an HD line. On the ward though, you probably shouldn't.

ArvinC EMT, ADN, BSN, RN · Mar 1, 2016

Well, I have only been in the ED like for about 6 months, and no one told me ever that I can't run anything through a HD line, cause I have actually done it in the ED before like last year when I was in orientation. And when I was in LTACH we also ran abx through a HD subclavian line. The nurse relieving me went up to the charge and the charge came to me "You are never supposed to that." So then I went to the ER physician and said I ran the abc through the HD line and I wasn't supposed to. He said "start another IV, and run the rest of it through the IV". Then the charge told the other nurse that they do it on the dialysis floor we don't do it down here because we don't have heparin, it's not really a big deal. So meh lesson learn, I guess.

idialyze, BSN, RN · Mar 1, 2016

Please , Please don't use a Dialysis Catheter without an order from the Nephrologist! As was said above this is the patients lifeline, and must be cared for properly!

If they have no peripheral line, call your Dialysis Team, for antibiotics and several other drugs, they must be given after a treatment to avoid being dialyzed out. Also, blood transfusions should be given during dialysis.

Just let us know what is needed, and we will be glad to help you!

There is also a specific protocol for flushing and capping them.

AlabamaBelle · Mar 1, 2016

In my experience, only the Nephrologist can order that anything other than HD and HD related medications be delivered through the HD catheter. Since these patients have little to no kidney function, timing is critical as well. Some patients are incredibly fluid sensitive. Best practice is to start a PIV. Also, these catheters tend to be blocked with higher concentration of heparin (5,000 units). If you fail to aspirate, then the patient gets a heparin bolus. After treatment, if the patient needed a fluid bolus, we were not allowed to use the catheter. Patient had to be admitted and fluids administered via PIV.

That this catheter is the patient's lifeline cannot be overstated.

hawaiicarl, BSN, RN · Mar 1, 2016

Yes, you can draw blood, and run meds through a HD line .... you can also explain to the Dr. how you messed up the pt's only access. Then you can explain why you just gave the pt 2000 units of IV heparin as a bolus which is instilled into each lumen of the line. Is that sarcasm? Mebbe.

Cheers

Penelope_Pitstop, BSN, RN · Mar 1, 2016

Another thing about the "lifeline." If that bugger gets infected (CLABSI!), then the patient is royally, royally screwed.

I worked with a nurse who googled how to access dialysis caths because phlebotomy couldn't get peripheral blood.

Nephrology was NOT happy.

Wrench Party · Mar 2, 2016

At both my facilities, we don't touch dialysis catheters AT ALL except make sure the dressing is intact. If the patient doesn't have a central line, that's when you discuss with the team to get one, or throw in a PIV for access.

Guttercat, ASN, RN · Mar 2, 2016

Well, I have only been in the ED like for about 6 months, and no one told me ever that I can't run anything through a HD line, cause I have actually done it in the ED before like last year when I was in orientation. And when I was in LTACH we also ran abx through a HD subclavian line. The nurse relieving me went up to the charge and the charge came to me "You are never supposed to that." So then I went to the ER physician and said I ran the abc through the HD line and I wasn't supposed to. He said "start another IV, and run the rest of it through the IV". Then the charge told the other nurse that they do it on the dialysis floor we don't do it down here because we don't have heparin, it's not really a big deal. So meh lesson learn, I guess.

Well, it's not really "meh no big deal."

A (tunneled/permanent) dialysis CL has its terminal end in the R atrium. It is a fantastic corridor for bacteria to set up shop on or in the dialysis line itself (develop vegetations), to enter the heart, and or the bloodstream at large.

Every time a dialysis line is accessed, be it by dialysis personnel or other, is an opportunity to present bacteria into the line.

It's not that you're not "smart" enough to handle the procedure. What we are doing is trying to minimize risk of screwing up the line, or giving the patient a raging case of bacteremia or endocarditis. We do this by accessing (using) the line as little as possible, and limiting the number of people messing with it.

idialyze, BSN, RN · Mar 2, 2016

Well, it's not really "meh no big deal."
A (tunneled/permanent) dialysis CL has its terminal end in the R atrium. It is a fantastic corridor for bacteria to set up shop on or in the dialysis line itself (develop vegetations), to enter the heart, and or the bloodstream at large.
Every time a dialysis line is accessed, be it by dialysis personnel or other, is an opportunity to present bacteria into the line.
It's not that you're not "smart" enough to handle the procedure. What we are doing is trying to minimize risk of screwing up the line, or giving the patient a raging case of bacteremia or endocarditis. We do this by accessing (using) the line as little as possible, and limiting the number of people messing with it.

Can not like this any more, that " meh" really ****** me off! What if this was your mother op?

sandytoes · Mar 2, 2016

My unit often sees patients with a "nurse port" off a HD cath. I'm still nervous to even use those, never mind touch the HD cath (never never never). Any advice on those? Besides the obvious of good central line care/maintenance?

chare · Mar 2, 2016

My unit often sees patients with a "nurse port" off a HD cath. I'm still nervous to even use those, never mind touch the HD cath (never never never). Any advice on those? Besides the obvious of good central line care/maintenance?

What is a "nurse port?"

sandytoes · Mar 2, 2016

What is a "nurse port?"

It's a lumen that looks like a lumen on a Picc or central line. I don't know if they have another name?! There are the 2 HD ports/accesses (usually taped off/together) and then the one lumen flopping out of there too that is used as a usual access for fluids or meds. I feel like I hijacked this thread (sorry!) so I can ask this somewhere else if I need to!