Did a dumb thing r/t dialysis port

fusster · Sep 12, 2008

I'm not a dialysis nurse, but here's my understanding. Dialysis ports (Permacaths, Quinton caths) are usually the only way for a patient to get dialysis. If you draw off of a dialysis port, you risk not flushing it properly and clotting it off. If it gets clotted off, it is useless. The dialysis nurse will not be able to perform the dialysis. Therefore the patient is unable to get the dialysis their life depends on, their BUN/Creat rises, their electrolytes go out of whack, their BP rises, etc, and they may ultimately die from the complications. Also, if it clots off, then the port will need to be removed and a new one inserted, resulting in preventable medical costs. Overall, bad for the patient.

If you ever draw off of a dialysis port by accident, be sure to call the nephrologist (and be ready to be yelled at) and call the dialysis nurse to come and ensure that the port is flushed properly. I believe the heparin solution that is instilled into dialysis ports is more concentrated than the heparin solution for central lines (although that may vary by hospital). Except in very few instances (and I mean very few), dialysis nurses should be the only ones to ever touch dialysis ports.

Again, not a dialysis nurse, so dialysis nurses feel free to correct me or add any other useful info.

vamedic4, EMT-P · Sep 12, 2008

As fusster put it...the reason you can't unless you have specific orders to do so is because the HDC is their lifeline And unless you have the nephrologist's okay it is unwise to do it. We do it in peds but only with the attending nephro's okay, usually because most of our kids are incredibly difficult sticks.

TexasPediRN · Sep 12, 2008

Yes, you may have messed up, but its not the end of the world.

Dialysis nurses draw blood and cultures out of the line ALL the time, so its completely possible to do so.

We just let dialysis handle it as its 'their line, not ours'.

On the pedi patients, a typical central line flush is 30 units heparin. A Dialysis cath (again, only done by them ) is 5000units heparin.

They just handle it so that we dont risk loosing the line.

You have learned a lesson, and you wont forget it now. We all make mistakes, its ok. You are learning!

soulofme · Sep 13, 2008

Yea and you touch that cath again and you owe all the dialysis staff a nice dinner:D

diabo, RN · Sep 15, 2008

In our acute unit, we've made up a travel kit for drawing labs from the H D catheter. It has everything that is needed, (except the heparin) including a detailed policy and procedure. One of us normally can draw for the nurses, but the kit allows others to draw without us having to be there. It has worked out very well, especially at 0200. Each unit has a copy of the P&P and knows where to get the kit.:typing

iluvivt, BSN, RN · Sep 15, 2008

Agree with all said with a few additions. You can use Tpa (cath-flo) to re-establish patentcy or remove fibrin sheath or build-up, you do not have to remove a HD cath if it is clotted. If the MD suspected a Catheter-related bloodstream infection from the HD catheter it is accepted practice to draw a culture from the suspected CVC and then one from a peripheral vein. If there is a CRBSI you will see approx a ten fold increase in the bacteria ct in comparison to the peripheral draw. Was that the case? Routine use of a HD cath is a no-no as stated but we sometimes get permission to use it in a pinch or if we want to draw a culture specifically from it. Really not a big deal Most non-tunnelled are flushed with NS followed by 1000 units per ml (1-2 ml) Tunnelled dialysis are NS then 5000 units per ml ( 2-3ml) Again,this varies by region,hospital and nephrology preference.

Creamsoda, ASN, RN · Sep 26, 2008

Yes you can draw cultures off the HD cath, especially if you think its infected. Its just better to have someone who is trained in the matter to do it. On our unit (ICU)...we do CRRT and hemo, we treat the catheters sterile...so whenever we flush with citrate, are conecting, disconecting, we treat it as sterile as possible. Even if we were to draw cultures, we would have sterile glove and mask on. We cleanse the whole port, and line with chlorhexidine, to ensure it stays clean. There is also a risk of injecting the heparin or citrate into the pt. if you didnt know the lines were locked with an anticoagulant. (The line should be labeled). Then when the cultures are drawn, the lines need to be flushed and locked with the anticoagulant using proper technique.

jnette, ASN, EMT-I · Sep 26, 2008

Yes you can draw cultures off the HD cath, especially if you think its infected. Its just better to have someone who is trained in the matter to do it. On our unit (ICU)...we do CRRT and hemo, we treat the catheters sterile...so whenever we flush with citrate, are conecting, disconecting, we treat it as sterile as possible. Even if we were to draw cultures, we would have sterile glove and mask on. We cleanse the whole port, and line with chlorhexidine, to ensure it stays clean. There is also a risk of injecting the heparin or citrate into the pt. if you didnt know the lines were locked with an anticoagulant. (The line should be labeled). Then when the cultures are drawn, the lines need to be flushed and locked with the anticoagulant using proper technique.

Very Good! :)

Hey.. if you were asked to draw a culture, then the very place you would want the culture drawn from IS the access line..in this case the central line. So you did right.. one needs to establish if the infection/bacteria is line related (as in the line itself) or systemic.. or tissue alone.

At dialysis we were often asked to draw blood cultures form the cath in order to establish this.

But your concern is a good thing, too. Yes, this IS their lifeline. If not absolutely neccessary to access it, don't. That simple. :up:

mmurphy · Oct 16, 2008

Many units use heparin 1000units/ per ml , and draw up the amount needed to fill the volume of the catheter. 2ml or under is the average amount needed for each port. some current evidence suggest that just filling the lumens/ports of the dialysis catheter fwith NSS is adequate enough to keep the catheters from clotting. The important factor is to make sure you have enough solution to fill the volume of the lumens. 5000units/ per ml is an unecessarily high dose, and is not rotinely used in most dialysis units. Hospital units are more prone to use these higher does amounts, becasue hopital dialysis units have inferior knowledge re: dialysis comapred to for -profit dialysis systems; such as fresenius, or Davita.

iluvivt, BSN, RN · Oct 16, 2008

There is no current consensus or enough evidence to support flushing all CVCs and including HD catheters with NS only. It has only been concluded that NS is as effective as heparin in maintaining patency on peripherals only.Research is ongoing on testing alternate flush solutions. Our Nephrologist like us to use the 1000 units per ml 1,5 ml and mix that with 1 ml NS and we use a little more on the tunneled HD catheters.

land27 · Oct 17, 2008

A dialysis patients access is there life line. Without it they could die in in a few days to a week or so. Hemodialysis also requires that access to be able to handle blood flow rates up to 350-400ml/min and sustain that rate for hours at a time. So to say the least. For our patients, anything that might cause removal or damage to this access is not only another invasive procedure and all the risks that go along with them but also extended hospital stays for nosocomial line infections and delayed treatments due to clotted/damaged accesses. Most Dialysis units also use heparin 5000units/cc for locking the catheter between treatments, while reversable, it could be fatal to a head blead or surgical patient with bleading issues if a floor nurse accidently flushed those lines without first drawing a discard. I hope this has provided you with an answer to you question.