How to take care of the hemodialysis catheter?

The hemodialysis catheters should be taken care to prevent the possible infections and clots formation in the veins and arteries where the access is created Catheter cleaning and safety usage 

The following step includes 

• Maintaining aseptic conditions while or after the completion of procedure
• The clamps and caps should be tight enough when the catheter is not in use because this may lead to air entrap which affects the flow of the blood.
• The site of inserted area should be properly dressed and sealed to prevent exposure to moisture which may lead to infections or even worsening of existing infection 
• If the catheter site have pain or redness that may indicate the signs of infection which should be immediately taken to the team notice 

• Should consider either pre or post dialysis cleaning 
• For cleaning with betadine or spirit soaked cotton,initially start from inner that is i;e insertion site  to outer catheter(periphery) cleaning protocol should be followed 
• Patient should be advised to maintain hygiene around the site of insertion area 
• Apply antibiotic ointment  and seal the area with primapore or  tegaderm or by any surgical band 
• Avoid using dynaplast which may layer off the upper skin surface and leads to more pain and damage 
• To check blood flow ,1-2 ml of blood is drawn from the one end of catheter  then discard it back through the other end of the catheter .Finally ,flush the lumen with normal saline 
• This process will  removes the clot and bacterial infections
• Lastly ,clean the top of the catheter with sterile cotton or guage piece and lock the top with heparin or antibiotic 
• Instructions and procedure should be followed according to the Unit protocol for heparin diluted with  normal saline 
• Kt/V should be 1.2 and URR should be 65 and above if patient receives dialysis treatment,if values lower than this indicates the access is not in well condition to work enough
• Most often ,even after careful consideration clots and infection cannot be prevented .
• So,It is essential to maintain the catheter from getting blockage 
• Even though conditions are well maintained the negative effects from getting infected cannot be controlled .It is an requirement to carry an emergency antibiotic kit or immediate response from the team
• The signs and symptoms of infection include Fever,chills,Redness or tenderness at the site of insertion,weakness and fatigue ,Drainage,tenderness

What happens when the catheter fails to perform well?

• As a result of clot or infection the blood flow rate will slowly declines or decreases
• This should be checked regularly once per week or so
• pre-pump arterial pressure alarms,happens due to a clot formation which blocking the catheter for a free flow of blood 

Treatment

• For infections, Antibiotics medications  or Antibiotic applications such as mupirocin ointments can be considered
• In case of bacteremia or sepsis an intravenous antibiotics are advised 
• For clot removal medications such as tissue plasminogen activator (tPA)
• tPa is advised just before the treatment of the next dialysis sessions 
• tPa is injected through catheter into vein ,where should remain for 25-30 min ,if the clot remain the process is continued until the desired results 
• In case of blockage of entire catheter the condition worsens in form of exaggerated signs and symptoms can be treated simply by replacing the existing Catheter with the new one 

What happens if you treat clot or infections early ?

• Hemodialysis works efficiently by removing toxins and excessive fluid in the body which happens as a result of enough blood flow
• Good flow of treatment without further interventions to the treatment 
• Improved expected quality of life for longer durations

Patient role to take care of catheter?

• Knowledge on your blood flow rate, the amount of dialysis ,Kt/V or URR values which help to assess the level of condition 
• Regular visits to doctor for follow ups, dialysis schedules ,doubts regarding the maintenance of Catheter will definitely benefit improves the condition

Frequently asked questions