Hospital policies and procedures

MunoRN, RN · Mar 4, 2017

That's not really something a hospital specific policy is required for, proper considerations and technique for removing a temporary dialysis catheter doesn't change based on geography. There generally should be some sort of general nursing practice reference, either an online resource like Mosby's, or nursing practice references either on the floor in the library.

iluvivt, BSN, RN · Mar 4, 2017

Perhaps they have a policy on how to remove any type of CVAD that is not tunneled.Look in the central line policy You must take the necessary steps to prevent air embolus(AE) in knowing how to properly position your patient and how to seal the entrance site with some type of ointment or vaseline gauze.Since HD catheters are large the risk for AE is a concern.How did it go?

nutella, MSN, RN · Mar 4, 2017

Hi all,
just wanted to get opinions/advice. I recently started working at a hospital and am currently in orientation. Today I had a patient with an order to remove a temporary hemodialysis catheter. I have done this skill previously at my old hospital and there was a hospital specific policy on how to do it. I wanted to look up the policy on how it is done at the new hospital I am working now but when I asked my preceptor where I could find the policy on hemodialysis catheter removal she could not find it so we asked the manager of the floor what the policy for this was. The manager did not know where the policy was or anything about it. I was getting the feeling that not many people who work here look up policies and procedures because no one could help me find it. I even called the AOD of the hospital and no help. Now I don't know if it's just me and I'm overly cautious with making sure I follow hospital policy but the last place I worked I always looked up the policy on how to do certain procedures I wasn't totally comfortable with. Am I crazy? shouldnt the hospital have easy access to policies and procedures like this? Is it weird that not even the floor manager or charge nurse could direct me to finding the policy for this?

A temporary dialysis access is commonly understood to be a non-tunneled central catheter - usually a double lumen catheter that is placed in the internal jugular vein ("IJ"). The access can be used until a tunneled catheter is placed or, if just needed few dialysis session for example lithium overdose, gets removed.

Most hospitals I worked at do not have a separate policy for the removal of temp dialysis access - information about how to remove an IJ can be found under "central line" removal, central line access and so on. It often includes who "owns" the line as well. Commonly, dialysis nephrologists do not like to co-share their lines because the risk of infection is high as well as clotting when not locked properly, which applies to all catheters for dialysis purposes.

The IJ catheter has a significant size (diameter) - removing it requires knowledge and skills - this web page has some good points:

CRITICAL POINTERS: Removing a central venous catheter

If your facility allows nurses to remove central lines you need to make sure that you understand how to do it correctly and the risks etc. Some facilities do not allow nurses to remove those catheters or it needs to be removed by dialysis.

I have removed those catheters many times and have always gone through the same steps of

-checking that P&P allows me to remove the access

- order is placed by MD

- coags are ok including platelets - otherwise call MD and discuss

- make sure that I have at least 10 minutes time

- position patient flat with head down - I actually prefer to tilt the bed if I can and pat tolerates so that the legs are higher than the head in addition for positive pressure to avoid air embolus.

Take off the dressing per policy, remove stitches

- when ready to remove the catheter folded 2x2 in the left hand, have in addition pat take a deep breath and hold breath - and remove the catheter with the right hand in a slow steady move.

- I typically was holding pressure for 5 minutes, after that applied an occlusive dressing with gauze and tegaderm.

- sit patient up again, some teaching, and monitor the site for some minutes to make sure it is not bleeding or the dressing comes off.

I worked at highly regulated places that have many P&P in place including one that tells you that "underwear should be worn but not be visible" and I work now at a place that has P & P but not in excess because it allows the staff to meet the needs of the patient better.

There are P & P of course but not in detail for everything and anything (including underwear.....) - if something is not governed by P & P there is still "best practice" and you can always ask the charge nurse/manager/ supervisor if you are unsure.

Toadd35 · Mar 4, 2017

i understand, I guess I thought most hospitals had policies on how to remove central venous accesses and I wanted to make sure I was following policy. I'm still in orientation and I thought it was odd that neither my charge nurse or manager could answer my questions about the removal of such accesses