Dialysis Subclavian line antibiotics.

[ArvinC EMT]

So I am wondering, is it wrong to run an ABX through a dialysis subclavian line? I mean it's still a central line? I was told in the ED you can't run abx through a dialysis subclavian line. Any reasoning behind it????

[sandytoes]

Just had to google more. It's apparently called a triple lumen hemodialysis catheter. I had never seen one before my current unit. They are pretty handy!

[chare]

Just had to google more. It's apparently called a triple lumen hemodialysis catheter. I had never seen one before my current unit. They are pretty handy!

Straight Triple Lumen Catheter

If your referring to something similar to this, you should be okey as this is a separate lumen, not used for dialysis.

[Magsulfate, BSN, RN]

Straight Triple Lumen Catheter

If your referring to something similar to this, you should be okey as this is a separate lumen, not used for dialysis.

This is what I was trying to describe as the 'pig tail', I just couldn't think of what it was called... just treat it like it's a central line.

[idialyze, BSN, RN]

Just had to google more. It's apparently called a triple lumen hemodialysis catheter. I had never seen one before my current unit. They are pretty handy!

These are temporary lines inserted in an emergency or if the patients tunneled catheter is infected. The pigtail is ok to use for blood draws and med administration, they are safe for floor nurses to use. Check your policy for flushing protocol . They will be removed before patient is discharged after new permanent access is placed.

[0.adamantite]

The subclavian line has a larger amount of heparin instilled into it (I think at my facility it is 5,000 units). This must be drawn out before use or else the patient gets a bolus of heparin. We are not allowed to touch the subclavian and I wouldn't want to anyway.

[iluvivt, BSN, RN]

You are referring to a temporary percutaneously placed HD catheter with an additional lumen to be used as a central line. BARD makes one they call a Trialysis catheter. Covidien also makes a Mahurkar that is the same configuration. Flush this lumen per your policy,make sure you are scrubbing the hub and changing the cap at least every 7 days. Also check for a blood return and treat it with cathflo to restore it when needed! [h=2][/h]

[teacupRN]

At my facility, the head nephrologist considers any catheter accessed by the ED or the floor as "contaminated."

Also we pack with 1000unit/ml heparin for inpatient, but the outpatient clinics still use 5000unit/ml heparin.

[nutella, MSN, RN]

The huge risks with regular nurses accessing "permanent" tunneled central lines are infection, heparin injecting by accident, clotting with inability to dialyze.

As you may or may not know, the HD nurses go through great length to actually prevent infections when accessing or de-accessing the catheter. Unlike "normal" nurses, the HD nurse always wears a mask, ensures that the hubs/connections are desinfected properly.

A HD patient who looses a tunneled line for HD due to infection can have other problems besides dying from a blood stream infection. A temp line that needs to get places of a tunneled line is removed, often does not HD as well plus more uncomfortable plus not tunneled - another risk for infection. If a blood stream infection leads to vegetation on a heart valve and the pat requires heart surgery it is not always possible due to the risks associated with being a HD patient.

The dressings for central line are done strictly aseptic in HD.

Policies vary from hospital to hospital and it is important to know those.

But a central HD line should never be used because it is convenient. And drawing blood off the line increases the risk for infections greatly.

Usually non HD nurses do not touch the line. in some hospitals the IV nurse will access the line if there is a special need for it and with an order.

When I worked inpatient HD I did get calls sometimes to come and access a HD catheter and draw blood cultures ,in the ER for example, or to heparinize a catheter that was accessed for whatever reason.

But as a general rule - HD catheters are there for HD only and if there is a valid reason to access it (for example a code) it should be done by somebody who is trained to do so and with all precautions.

[Twinmom06, ASN, APN]

The hospital I work in 95% of the time does not allow blood draws out of our HD catheters period the end. Also our nephrologists will only write an order to use an HD catheter in a code situation for emergency drugs and only the venous (blue) port (and only for ICU patients). Abx while on dialysis are also by order only, and its usually only Vanco or Gentamycin.