dialysis vascular catheter

Indications

• hemodialysis

Procedure

Double lumen catheter for hemodialysis access. Subclavian & internal jugular catheters available. Subclavian catheter is longer & somewhat more flexible. An introducer kit plus a guidewire from a subclavian catheter is also needed.

Caution: Do not use the guide wire that comes with the introducer kit with a subclavian vascular catheter. It is too short.

The procedure is the same as for a triple lumen central venous catheter.

After flushing each port with enough saline to clearthe catheter lumens of blood, the vascular catheter is flushed with 5000 U of heparin in each port.

The blue lumen holds 1.4 mL, the red 1.3 mL.

Thus 0.5 mL of heparin 10,000 units/mLis diluted to 1.4 mL with normal saline & this is used to flush the blue port.

0.5 mL of heparin 10,000 units/mL is diluted to 1.3 mL & this isused to flush the red port.

Complications

• bleeding from catheter insertion site
  • desmopressin when platelet dysfunction due to uremia contributes to bleeding (bleeding with normal platelet count)

Management

• indications for removal of catheter
  • severe sepsis
  • hemodynamic instability
  • evidence of metastatic infection
  • infection of catheter exit site or tunnel
  • persistent fever &/or bacteremia > 48-72 hours despite adequate antibiotic coverage & no other suspected source
  • infection due to high risk & difficult to cure organisms, including Staphylococcus aureus, Pseudomonas or fungi
• indications to retain the catheter
  • stable patient with with uncomplicated bacteremia due to coagulase-negative Staphylococcus
    • retain the dialysis catheter, treat with vancomyin for 10 days*

* antibiotic lock after each session of dialysis also recommended

More general terms

• central venous catheter

More specific terms

• tunnel dialysis catheter (TDC)

Additional terms

• hemodialysis