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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 [1] - 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

Related

hemodialysis

Specific

tunnel dialysis catheter (TDC)

General

central venous catheter

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  2. Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter- related bacteremia. J Am Soc Nephrol. 2014 Dec;25(12):2927-41 PMID: 24854263 PMCID: PMC4243345 Free PMC article