Emergency Department Program
September 2020
Non-Dialysis Procedures on Hemodialysis Central Venous Access Devices In the Emergency Department
OBJECTIVE: To provide guidance for RAH Emergency nurses, to access hemodialysis (HD) line for procedures other than hemodialysis in Emergency situations.
POINTS OF EMPHASIS: 1. Any manipulation of the HD CVAD increases the risk of infection. This central line is the patient’s lifeline and, therefore: a. Every effort must be made to minimize accessing it for non-HD procedures. b. Blood sampling or intravenous (IV) administration should be coordinated with HD treatments when possible. c. In non-emergency situations and if no alternate IV sites are available, an order from nephrology services is required to access the HD CVAD. d. When accessing the HD catheter, aspiration of the locking solution is required with subsequent discard. e. It is essential to maintain sterility and perform proper disinfection of the connector prior to accessing the HD catheter. INTERVENTIONAL GUIDELINES: 1. Care and maintenance of these lines will primarily occur during hemodialysis treatments. 2. Needleless TEGO (yellow) connectors may be changed to Microclave Clear connectors following the connector change procedure outlined in the Clinical Care Knowledge Topic. a. If TEGO connectors are left in place, they must be changed every seven (7) days and as needed (PRN) if breakdown of the sheath is noted. b. If changed to Microclave connectors for non-HD use, they must be changed every four (4) days while line is in use c. Connectors must be changed in case of blood culture collection, presence of blood in the connector, etc. 3. Dressing will be changed every seven (7) days or as needed. These changes can be performed by any nurse who has completed competency training in CVADs following the AHS procedures for CVAD dressing changes. Dressing includes 3 medication labels- once for each port, and one for outside the dressing. One 4 x4 open completely and fold 4 x4 around the lumen secure with tape, and finally medication label on the outside. 4. These non-valved catheters require locking solution to maintain patency – this solution MUST be aspirated and discarded prior to use. ( Withdraw 3-5ml or until no clots present, utilizing a 10cc syringe).The lumen volume will be written on the lumen clamp. Utilize same solution and amount when locking off. a. Sodium citrate 4% b. Heparin 1000 units/mL c. TPA 5. If any difficulties with aspirating or instilling the HD CVAD, stop the procedure and contact HD unit/nephrology for further troubleshooting and/or call Rapid Response Team. 6. When locking with citrate 4%- administer slowly over 10-20 seconds. REFERENCES: ADAPTED from Alberta Kidney Care (AKC), hemodialysis Jan 2018) Alberta Kidney Care, Hemodialysis Practice Direction Document - Dressing Change – Central Venous Catheters. April 2017. Retrieve from http://insite.albertahealthservices.ca/assets/rs/tms-rs-akc-hd-pdd-dressing-change-cvc.pdf Alberta Kidney Care, Hemodialysis Practice Direction Document – Locking the Hemodialysis Central Venous Catheter. November 2017. Retrieve from http://insite.albertahealthservices.ca/assets/rs/tms-rs-akc-pdd-hd-locking-hd-cvc-catheter.pdf Alberta Kidney Care, Hemodialysis Practice Direction Document – Management/Troubleshooting of Central Venous Catheters. April 2016. Retrieve from http://insite.albertahealthservices.ca/assets/rs/tms-rs-akc-hd-apheresis-narp-pdd-management-troubleshootingcvc.pdf ICU Medical – TEGO Connector Vimeo Instruction https://player.vimeo.com/video/39227747?autoplay=0
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