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Caution: Do not pull apart the portion of the sheath that
remains in the vessel. To avoid vessel damage, pull back
the sheath as far as possible and tear the sheath only a
few centimeters at a time.
19. Make any adjustments to catheter under fluoroscopy. The
distal venous tip should be positioned at the level of the caval
atrial junction or into the right atrium to ensure optimal blood
flow.
Note: Femoral catheter tip placement is recommended at the
junction of the iliac vein and the inferior vena cava.
20.
Attach syringes to both extensions and open clamps. Blood
should aspirate easily from both arterial and venous sides. If
either side exhibits excessive resistance to blood aspiration,
the catheter may need to be rotated or repositioned to obtain
adequate blood flows.
21.
Once adequate aspiration has been achieved, both lumens
should be irrigated with saline filled syringes using quick bolus
technique. Assure that extension clamps are open during
irrigation procedure.
22.
Close the extension clamps, remove the syringes, and place an
end cap on each luer lock connector. Avoid air embolism by
keeping extension tubing clamped at all times, when not in
use and by aspirating then irrigating the catheter with saline
prior to each use. With each change in tubing connections,
purge air from the catheter and all connecting tubing and
caps.
23.
To maintain patency, a heparin lock must be created in both
lumens. Refer to hospital heparinization guidelines.
Note: Assure that all air has been aspirated from the catheter
and extensions. Failure to do so may result in air embolism.
24.
Once the catheter is locked with heparin, close the clamps and
install end caps onto the extensions' female luers. Tape end
caps between treatments to prevent accidental removal.
25. Confirm proper tip placement with fluoroscopy. The distal
venous tip should be positioned at the level of the caval atrial
junction or into the right atrium to ensure optimal blood flow
(as recommended in current NKF DOQI Guidelines).
Note: Femoral catheter tip placement is recommended at the
junction of the iliac vein and the inferior vena cava.
Caution: Failure to verify catheter placement may result in
serious trauma or fatal complications.
CATHETER SECUREMENT AND WOUND DRESSING:
26.
Suture insertion site closed. Suture the catheter to the skin
using the suture wing. Do not suture the catheter tubing.
Caution: Care must be taken when using sharp objects or
needles in close proximity to catheter lumen. Contact from
sharp objects may cause catheter failure.
27.
Cover the insertion and exit site with an occlusive dressings.
28.
Catheter must be secured/sutured for entire duration of
implantation.
29.
Record catheter length and catheter lot number on patient's
chart.
•
The heparin solution must be removed from each lumen prior
to treatment to prevent systemic heparinization of the patient.
Aspiration should be based on dialysis unit protocol.
•
Before dialysis begins, all connections to catheter and
extracorporeal circuits should be examined carefully.
HEMODIALYSIS TREATMENT
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