Home with temporary catheter

[Swansonck]

I'm am wondering if anyone can share if they have a hospital policy about sending patients home with a subclavian or jugular temporary dialysis catheter in place? We have MD's who write orders it is OK but we have no policy and I don't think it is best practice, but I can't find research on that either! Can anyone share thoughts or suggestions please!

[Tish88]

We don't have a policy on that topic, however, NO patient should be getting a subclavian catheter. These catheters should be placed IJ. Subclavian catheters cause too much vessel destruction, that causes problems down the line when a fistula or graft is placed.

Also, as labeled, these catheters are temporary. The hospital policy (not dialysis) states these catheters are to be exchanged every 3 days. There are no cuffs on these catheters for tissue ingrowth to prevent them from falling out and help with preventing infection.

Are these patients discharged with an appointment to have a tunneled catheter placed soon?

My thoughts are, these patients should not be discharged from a hospital without a tunneled catheter placed or an appt to have one placed at a access center immediately after discharge.

Check out the kdoqi guidelines for accesses - that is where you will find the best information and is the standard of care for dialysis patients.

http://www.kidney.org/professionals/kdoqi/guidelines_commentaries.cfm

Per the guidelines:

"Short-term catheter: A device intended for short-term use (1 week) that typically is not tunneled.

Intended for use in hospitalized patients; not for outpatient maintenance dialysis."

[Tish88]

above quote should state