need help re removal of temp. dialysis cath.

[snuggles49]

Can anyone tell me where to find information to write a policy for removal of a temporary dialysis catherter or send me your policy. This is for a hospital setting. Thanks

[jnette, ASN, EMT-I]

Hospital setting... ok. I imagine each has its own policies.

I was thinking that only the MD/Surgeon was the one to remove these.... but don't hold me to it.

[masaya]

yes,i do agree,each institution/hospital settings have thier own policy,in the hospital where i do work,femoral temporary access can be remove by nurses but a jugular and subclavian removal is never a nursing job,doctors resposibility.

Suggest to refer to KDOQI guidelines.Kindly check www.kidney.org

Hope it will help.Thank you.

[Lacie, BSN, RN]

I work in a chronic clinic and we do remove temp dialysis caths. Procedure pretty much is same as hospital, placing head down, deep breaths, pressure to site. MD isnt present but only the RN can pull. I'm not real comfortable with the practice myself as no cardiac monitoring in place nor adequate emergency equipment short of cpr if needed. Fortunately we have never had an issue related to adverse complications. I'm old school openheart/ccu so chronic clinic practices amaze me sometimes in relation to patient safety. Chronics get way to tunnel visioned not seeing the entire picture most of time (jmo).

[land27]

I would check out facilities policy first, however, a temporary hemodialysis cath. (femoral,IJ, or Subclavien) should be able to be pulled by an RN. The procedure is the same as for any other central line: HOB down, have patient take breath in and hold it and then pull line, apply pressure until hemostasis achieved. FYI: Rarely have I ever seen a temporary in the Subclavien....a tunneled dialysis permcath (with actually tunnels to the IJ usually) does exit the body where a typical subclavien placed cvc is customarilly seen, so use extra caution in such situations. A permcath must be removed by an MD.

[snuggles49]

Thanks. Some staff have pulled the temp caths. but we have not had a policy to do this. Same principles and procedures as removal of sheath from cardiac cath/ central line etc. Correct me if I am wrong. Thanks again