Emergency meds through IJ

Loo17 · Feb 13, 2015

An IJ is in the neck and not used for dialysis. A dialysis port should only be accessed according to facility policy. My facility policy states only a trained dialysis nurse or MD can access a dialysis port.

akulahawkRN, ADN, RN, EMT-P · Feb 13, 2015

An IJ would be seen on the neck, not the chest. What you might have seen was either a dialysis port or a subclavian line. Any which way you look at it, you'd have to follow facility policy/procedure for accessing those lines, even in the event of an emergency. As a paramedic, in a code situation, our own protocols would prefer that we access peripheral lines for those meds even if there's a central line of some sort in place. If there's only a central line available, then we could access the central line. They would prefer that we not access dialysis shunts as our catheters aren't designed for that purpose and will damage them. It would be rare for us to have Huber needles for those implanted ports...

If you're accredited by your facility to push code meds, you truly owe it to yourself to become very familiar with your facility's policies regarding accessing vascular access devices of all types for various situations, specifically which ones you may access and which ones you may not, and under which conditions.

TNValley · Feb 13, 2015

Most of the nephrologists and vascular surgeons I know would raise an eyebrow and give that head-tilt-silent-it-just-dropped-60-degrees-in-here stare to using a CVC for anything but dialysis treatments. Some wouldn't have a problem with it as a last resort to save a patient's life.

Guttercat, ASN, RN · Feb 13, 2015

In an emergent situation (as in the patient is crumping-about-to-die, and has no other viable alternative access), either a temporary dialysis catheter (seen in the neck) or a permanent dialysis catheter can and should be used for emergent meds.

In an acute setting, they can also be used as a last resort for infusions-- such as antibiotics and vasoactive drips-- as long as the person infusing has MD orders to use it (usually cleared by the nephrologist), and is trained per facility protocol in how to access and de-access. Again, last resort. The more a dialysis catheter is accessed, the more the potential for biofilm and fibrin to accumulate. These lines are the patient's lifeline--and replacing them increases the odds that there will be long term vascular impairment (such as stenoses and infection) for the patient.

Certain dialysis catheters can also be used for CVP measurements. Trialysis catheters are even more flexible in terms of potential uses.

I urge you to do some basic research via google. There are many different dialysis catheters with varying lengths, bores, materials, and placements/ acceptable uses.

Guttercat, ASN, RN · Feb 13, 2015

An IJ is in the neck and not used for dialysis. A dialysis port should only be accessed according to facility policy. My facility policy states only a trained dialysis nurse or MD can access a dialysis port.

Oh really?

Please don't confuse the OP. Anecdotally speaking (off the top of my head), 100% of the new onset/ Acute/emergent dialysis calls I get involve emergent/temp dialysis catheters placed "in the neck."

Chisca, RN · Feb 14, 2015

I would use it in an emergency which is what your patient was experiencing. Hate to have to testify that the pt died because hospital protocol only allowed dialysis nurses to access. It is a central line like any other and should be treated as such. Wear a mask, scrub the access port with chlorahexidine, and know whether or not it is heparinized. If there is a heparin lock it must be aspirated or you risk giving the patient a heparin bolus. I have seen upwards of 7,500u of heparin to lock ports. Always flush with 20cc saline after each medication to ensure patency.

kdunurse · Feb 14, 2015

Your facility should have a policy regarding use of a dialysis catheter for non-dialysis reasons. (I'm assuming you work in an acute care facility). In my facility, we do have a policy allowing non-dialysis nurses to use the dialysis cath for blood draws, but in my experience, most non-dialysis nurses are not comfortable accessing a dialysis cath. If you don't know what you're doing, you could do more harm than good by introducing infection or pushing in a dose of heparin or TPA packing accidentally.

Trauma Columnist · Feb 15, 2015

All of this confusion on the part of the original poster as well as the rest of us points to this for me:

1. KNOW what type of line you are accessing.

2. Be familiar with your facilities' policy and procedures regarding all central lines

3. Yes, while permcaths can be/and usually are, locked with heparin it is important to understand what concentration is used and how much is used.

4. Again, review #1.

Best wishes.

Loo17 · Feb 18, 2015

Oh really?
Please don't confuse the OP. Anecdotally speaking (off the top of my head), 100% of the new onset/ Acute/emergent dialysis calls I get involve emergent/temp dialysis catheters placed "in the neck."

You are correct. I was not even considering a temporary dialysis catheter. Where I work they use the groin for temporary catheters which is maybe why I had a lapse in brain function. My intent was not to confuse the OP, sorry for that!

Guttercat, ASN, RN · Feb 19, 2015

You are correct. I was not even considering a temporary dialysis catheter. Where I work they use the groin for temporary catheters which is maybe why I had a lapse in brain function. My intent was not to confuse the OP, sorry for that!

LOL! I can't tell you how many lapses in brain function I've had over the years, so I get it. :)

Curious though, you say that where you work they primarily access the femoral (groin) for temp catheters? That's weird. Usually a femoral cath is last resort for temp dialysis caths. I'm interested to know if there is a school of thought out there currently that finds the femoral preferable to an IJ.

The "rules" are always changing!

Loo17 · Feb 19, 2015

LOL! I can't tell you how many lapses in brain function I've had over the years, so I get it. :)
Curious though, you say that where you work they primarily access the femoral (groin) for temp catheters? That's weird. Usually a femoral cath is last resort for temp dialysis caths. I'm interested to know if there is a school of thought out there currently that finds the femoral preferable to an IJ.
The "rules" are always changing!

As far as I am aware, nationally the right IJ is still the preferred site. I would have to check with the docs for a definitive answer. I have been told a number of things...placing a temp catheter in the ED, the femoral is an easier access point in an emergent situation and doesn't require xray confirmation to use. We most often place them in patients with pulmonary edema or hyperkalemia and I have been told the femoral is preferred in those patients. I will have to ask one of the ultrasound fellows for the real rationale next time I see them.