Dialysis catheter

[Pharmahaulic]

If a dialysis catheter is inserted into a large vein like the superior vena cava, it obviously will have to travel through a smaller vein first such as the jugulag vein, so when it gets into the larger vein there will be extra space on the sides of the catheter for blood to sneak through? Is there a balloon or whatever that inflates to create a tight seal?

[Pharmahaulic]

The machine will alarm, notifying the nurse or dialysis tech running the machine that there is reduced flow who then troubleshoots, it may be that the patient has turned their head too far, the external line is kinked, etc.

So how do they get more flow in the catheter?

[MunoRN, RN]

So how do they get more flow in the catheter?

Find and fix anything restricting flow, if that doesn't improve the flow, then a reduction in flow rate may be necessary although there is a limit to how much you can slow flow the dialyzer and still have it work, if that's not an option then placing a new line may be required.

[Julius Seizure]

I think other posters have given really good answers. Now, who do I speak to about renaming this blood vessel the "jugulag vein"? I love it so much!

[hawaiicarl, BSN, RN]

Often short term dialysis catheters will suck up against the vessel wall, and like Muno says you may need to adjust your blood flow rates lower to account for this, say go from 200 ml/m down to 150. Other tricks you can do are giving an albumin bolus, it may be that you sucked them dry, and their vasculature is collapsing on the catheter, or you can reverse trendelenberg them to fill the SVC for easier flow.

Cheers

[Twinmom06, ASN, APN]

An HD catheter is placed by making 2 small incisions on (usually) the right side of the neck. The catheter is threaded through the IJ into the R atrium of the heart (in the case of a tunneled permanent catheter). There is a capsule that is anchored to the collarbone which serves the purpose of acting as an antimicrobial barrier, as well as to keep the catheter in place. As far as not sucking enough blood, usually we have the patient turn their head, raise or lower the head of the bed, or propping the shoulder to promote better flow. Also "reversing the lines" where you pull from the venous port and push back through the arterial is also a trick. Last resort is lowering the blood pump, but less than 200 rpm really is inefficient, promotes clotting of the extracorporeal system, and most docs will tell us to terminate the treatment.