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Judybeth
Temporary hemodialysis removal

The vascular access team and the critical care trained nurses at my hospital retouinely remove PICCs and CVCs in accordance with INS procedure. We have not removed temporary (nontunnelled) hemodialysis catheters. I couldn't find the rationale for not removing them so I asked some nurses who would have some historical knowledge. They spoke of the cather large bore size and the need to hold pressure for a greater period of time. The rationale was that it tied the nurse up longer than when removing a CVC or picc, so the MD's were only allowed to remove them. Is this outdated or is there any evidence that anyone can point me to? We don't have  dozens of them but we do get them and there is now controversy over whether the RN should remove them or not.

maggiemae
In our hospital they are

In our hospital they are considered a CVC.  Nurses remove them following the proper procedure with our CVC removal. One thought on the size of this catheter is similar to the cordis for a swan line.  Nurses remove a cordis.

lynncrni
This is only a large bore CVC

This is only a large bore CVC so a nurse with documented competency should be able to remove it. Same as removing any other percutaneous CVC. Control bleeding but air emboli prevention is more of an issue. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Judybeth
Thank you Lynn and Maggie. At

Thank you Lynn and Maggie. At my hospital we also do not remove the cordis and the renal doctors/intensivists/interventional radiologists often put a stitch in when removing a cordis or a temporary HD cath.  I am not opposed to having my IV nurses do this, but they have very large asignments and I do have concerns about how long they might have to stay at the bedside holding pressure ince we would not be able to place a stitch. Any comments about your experience with the differences in time of holding pressure betwenn a cvc and an HD cath woud be helpful to me.

lynncrni
Length of time for pressure

Length of time for pressure is a patient-specific thing based on clotting factors. Yes the hole will be large but I have not seen any one use a suture to close it and have doubts that it really serves any purpose. Some CVADs also leave very large holes. There would still be the need for pressure until hemostasis and a petroleum based dressing to seal the hole and prevent air embolism. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

maggiemae
holding pressure for CVC

I have personally not held pressure for more than 5 -7 minutes.  But, as Lynn stated it does depend on the specific patient.  Once the line is out you can sit them up and hold pressure, lightly.  I can only say with 30 years of ICU nursing it has never been a problem.

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