caffeinatedRN

Yes, that's what I lean towards. That 10% or so that don't give problems - I'm just curious if that is just a result of a skilled surgeon...something controllable.

You have dialysis orders on a patient post perm cath placement. Patient arrives from the OR, you verify placement and get them ready for the tx. You check the catheter for patency and have no issues - noting a smooth push and pull. You hook the patient up, everything runs ok for a little bit... and then the problems start. You start getting the venous and/or arterial pressure spikes, alarms, and overall feeling of frustration. You stop the machine and flush the catheter, noticing a huge difference with sluggishness of pull and push. Your wonderful, tedious adventure of a poor functioning perm cath has begun! This doesn't seem to happen on all perm caths immediately post surgery, just most of them. The possible theories are post surgical trauma induced swelling which either constricts the catheter and/or displaces it a bit...or the increased clotting response r/t trauma - or both. Does anyone know exactly why this happens? What are some ways around this? Postponing dialysis is generally out of the question. Stopcocks (3-way) have been useful to limit the stopping of the tx and constant disconnection of lines to flush ports with saline syringes (reduces infection risk as well). Heparin is generally a no-go right after surgery for obvious reasons. Some MDs may give a little heparin bolus (usually don't), some may suggest a Retavase/Alteplase medication instilled, others just say: try your best. Any suggestions?