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Accessing Dialysis Catheters

What are all of you doing with regards to accessing dialysis catheters?  Our current policy is for the ER or IV nurse to access only if in a code/life or death situation.  We were being bullied this evening to access a non critical pt. Tessio for fluid infusion.  This pt had a 22G and had no attempts at central placement by Dr. 


Daphne Broadhurst
In the past, only dialysis

In the past, only dialysis nurses accessed these lines. However, in an effort to preserve venous access of these patients, the decision was made by the nephro team, including the nephro vascular access nurse, to train RNs on the units at our institution to access these catheters. This has been in place for a few years now and, while I do not have the outcomes stats, I am confident that the vascular access coordinator would have halted this practice had significant negative sequalae been observed. Community nurses have also been trained to access these lines.   

Therefore, upon receipt of a PICC consult for a dialysis patient, the nephro vasc. access coordinator is contacted to determine if it is feasible for the pt. to receive the prescribed IV therapy via the pt's existing vascular access device.


Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Our facility requires
Our facility requires dialysis only nurses to access those catheters for non-dialysis uses, by order of the Renal Fellow, during the day shift (when the dial. nurses are in house).  After hours, only the trained IV RN's are allowed, and only with an order by the Renal Fellow.  The IV RN's in our facility are not cavalier about accessing these lines - very protective of them.  All other access options must be exhausted before using them, and we're very assertive with the MDs and RNs.Mari

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

we access only when critical

we access only when critical as well or with someone who has run the gamut and has absolutely nothing anywhere and not a candidate for any other central access (having had multiple dialysis catheter placements)

There is light at the end of the tunnel though.  We are switching to the MAHUKAR triple lumen catheter that has a third port for infusion.  Per the company, stats have shown no increase in infection as compared with regular dialysis catheters. Also a great dialysis catheter.

dialysis nurse
Does your anesthesia

Does your anesthesia department access those catheters during surgery and if so- do they leave the OR or PACU without capping the line off and instilling the heparin.  OUr concern is once they get to the floor, those nurses don't know how to care for the catheter.  Any suggestions would be appreciated.

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