Section 6: Your Hemodialysis Catheter

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1 Section 6: Your Hemodialysis Catheter What you should know about your dialysis catheter How to change your catheter TEGO connectors Starting dialysis using a catheter End of dialysis using a catheter Changing your dialysis catheter dressing What you should know about your dialysis catheter 1. Think clean. Clean, clean, clean. We cannot emphasis this enough. Protect yourself from infection. Wash your hands and use good technique every time you use your catheter. Keep in mind that you can never touch the ends of the catheter. Your catheter goes right into your heart. Bacteria that touches the ends of the catheter could potentially travel right to your heart. If you accidentally touch one of the open catheter lines or if you find that your catheter TEGO connector cap has fallen off, soak the end of the line with disinfectant soaked gauze for 1 minute Attach a new TEGO connector cap. Call your nurse. or hemodialysis unit if the TEGO connector cap was missing. Infections that are caught early are more easily treated. Take your temperature regularly Call your nurse or doctor immediately and go to the hospital emergency room if your temperature is 37.5C or higher.or if you have rigors [uncontrollable shaking ]and chills. Do not soak in a tub or go swimming with your catheter. 2. Watch for air. Always use your catheter clamps. Make sure they are closed every time you change your TEGO connector caps, connect a syringe or a bloodline. Keep syringes vertical when you check your flows so that air bubbles get trapped in the top of the syringe. INDEPENDENT DIALYSIS PATIENT WORKBOOK 1

2 3. Changing your dressing Change your dressing days per week (talk to your nurse). Many people change their catheter dressing after bathing. Try to keep your dressing dry. If it gets wet, change it. Use a mirror when changing your dressing. If you notice pain or redness around the catheter or any drainage, call your nurse. 4. Blood flow changes Changes from your normal blood flow or changes in usual arterial/venous pressure readings can mean there is either a clot forming in your catheter or a fibrin sheath may be growing around the tip of your catheter. If this happens tell your nurse. A medication can be added to your catheter line to safely dissolve the clot or fibrin sheath. 5. Only use for dialysis Your catheter should never be used for anything other than hemodialysis. Notes from training 2 BC PROVINCIAL RENAL AGENCY

3 How to change your catheter TEGO connectors What do you need? 2 clean drapes. 1 bottle of disinfectant solution 4 gauze packages (4x4" squares) 2 TEGO catheter connector caps 2 plastic clamps or tape Hand sanitizer Related points to note TEGO connectors are changed weekly. If the TEGO connector becomes loose or falls off, make sure the catheter remains clamped. You are at risk for infection or air entering your bloodstream, and need urgent care. Call your nurse and go to your hospital emergency room. Instructions 1. Wash your hands for a full minute. 2. Remove gauze dressing from catheter lines. 3. Sanitize hands and put on mask. 4. Prepare your supplies on a clean drape 5. Carefully peel open TEGO connector package. 6. Tape or clamp second clean drape to your shirt under the catheter lines. 7. Pour 10mL disinfectant solution onto a 4X4 gauze Wrap soaked gauze around each catheter line. Rub for 1 minute to clean. 8. Remove the 4X4 gauze and place catheter lines on a dry 4x4 gauze. Air-dry the catheter lines for 1 minute. 9. Ensure the catheter clamps are closed. Carefully remove old TEGO connector from arterial limb and discard. Use a 4X4 gauze soaked in disinfectant solution to clean the arterial catheter end. Do not touch open ends with your hands. 10. Remove protective blue end from new TEGO connector cap. Attach male luer of TEGO connector cap to the arterial line. Do not touch ends. 11. Repeat above steps to change venous TEGO connector cap. 12. Wrap catheter ends in a clean, dry 4x4 gauze and tape INDEPENDENT DIALYSIS PATIENT WORKBOOK 3

4 Starting dialysis using a catheter Have machine set up and ready to go BEFORE you open up your catheter. What do you need? 2 clean drapes 1 bottle of disinfectant solution 2 alcohol swabs 4 gauze packages (4x4 squares) 3 (10mL) syringes 4 (10mL) prefilled saline syringes 1 bottle of heparin 1000 units/ml 1 21 gauge needle Tape (1 inch) 2 plastic clamps Small garbage bag Table mirror with a stand Face mask Hand sanitizer Why is this important? To keep blood off your table and to keep your surfaces clean. Amuchina may be used as an alternative to chlorohexidine solution. To help you see your lines. To prevent contamination. Optional supplies Blood detector (enuresis alarm) if you will be sleeping while on dialysis. Gloves (have your helper use them). Instructions 1. Wash your hands for a full minute. Related points to note Washing your hands is the best way to prevent infection. 4 BC PROVINCIAL RENAL AGENCY

5 Instructions cont. 2. Prepare your supplies on one of your drapes. a) Draw up your initial dose of heparin using a 21 gauge needle, a 10mL syringe and an alcohol swab b) Half open 2 10mL syringes, but leave ends inside the wrappers. c) Half open all (4x4) gauze packages with the bottom paper of the package still intact. d) Pour approx 10mL of disinfectant solution onto the gauze 4x4 s. e) Remove old gauze covering catheter. (never use a scissors) f) Clip drape to your shirt under your catheter lines using 2 clamps. g) Wear a clean mask if you are due to change TEGO connector caps. Related points to note cont. To keep blood off your table and to keep your surfaces clean. Swab the top of the heparin bottle with an alcohol swab. Leaving them in the packages keeps the ends sterile. Be gentle and avoid tugging on the lines. To prevent accidentally cutting catheter lines Keeps your clothing clean. To avoid breathing on your open catheter lines. 3. Clean your hands. Using hand sanitizer. To eliminate germs. 4. Clean catheter ends. Wrap each catheter end with a 4x4" gauze soaked in disinfectant. Rub each catheter end for 1 minute. Place dry gauze under cleaned lines and leave to dry for at least 1 minute. Note: If you are due to change your TEGO catheter connector caps follow steps on Page 3. Attach new TEGO connector cap with empty sterile 10mL syringe already attached. Repeat on other side and then proceed with Step 5. Be careful not to touch line ends with your hands, gloves or anything else. INDEPENDENT DIALYSIS PATIENT WORKBOOK 5

6 Instructions cont. 5. Remove sodium citrate or heparin. Attach an empty 10mL syringe to each TEGO connector cap (if you have not already pre attached for a scheduled TEGO change). Working one catheter line at a time, open clamp and pull back on syringe plunger to remove 4 5mL of blood. Close clamps on both lines. Related points to note cont. When using connectors some pressure is necessary to connect securely. Watch for air! Ensure your syringe is in a vertical position. 6. Flush lines with saline. Remove each 10mL syringe one at a time and replace with a10ml pre filled saline syringe. Open the arterial (red) line clamp. Push through saline and repeat with a second 10mL pre filled saline syringe. Next pull back and forth on plunger 3 times to check the flow of blood. Syringe must be in a vertical position. Repeat above procedure with the venous (blue) line. Be careful not to touch lines ends with your hands, gloves or anything else. Sometimes the catheter inside your blood vessel moves and the end of the catheter may get stuck on the side of a vein. If you notice a decrease in your arterial blood flow, change your body position and cough. This can help to move the catheter back to its correct position. If it is still difficult to pull up the blood in the syringe, check the troubleshooting guide (Section 12). Do not attempt to hook-up if you have a poor blood flow. 7. Give initial heparin bolus. Replace the 10mL syringe on the venous line with the heparin loading dose syringe. Push heparin in and pull back and forth on syringe plunger 3times. Close clamp on the lines. 6 BC PROVINCIAL RENAL AGENCY

7 Instructions cont. 8. Connect to machine Connect to blood lines, open catheter and bloodline clamps and start dialysis. If you will be sleeping while on dialysis, tape enuresis alarm at join of venous bloodline and catheter Wrap catheter with a dry 4x4 gauze. Related points to note cont. See machine flip chart for procedure. Enuresis alarm will sound if it detects moisture. Make sure you use this if you sleep while on dialysis. INDEPENDENT DIALYSIS PATIENT WORKBOOK 7

8 End of dialysis using a catheter See your machine flip chart. What do you need? 2 clean drapes 1 bottle of disinfectant solution 1 alcohol swab 2 gauze packages (4x4 s) Tape (1 inch) 4 10mL pre filled saline syringes 2 5mL pre filled Sodium Citrate syringes If you use heparin to block your catheter after dialysis you will need: 2 21 gauge needles 1 alcohol swab. 2 3mL syringes 1 bottle of heparin (1000 units/ml). Why is this important? To provide a clean working area Swab the top of the heparin bottle and ensure clean technique while drawing up heparin. 8 BC PROVINCIAL RENAL AGENCY

9 Instructions 1. Wash your hands for a full minute. Related points to note This initial wash removes oils from your skin. Washing your hands is the best way to prevent infection. 2. Prepare your supplies on your drape. a) Prepare your sodium citrate 4% syringes. Using the plunger, expel excess sodium citrate. You need ml in each syringe. b) Half open 4x4 gauze packages with the bottom paper of the package still intact. c) Pour approximately 10mL of disinfectant solution onto a gauze package. d) Clip drape to your shirt under your catheter lines using two clamps or tape. e) Give back your blood and take sitting and standing blood pressures (see your machine training manual or flipchart). Leaving them in the packages keeps the ends clean. Keeps your clothing clean. 3. Clean your hands. Using hand sanitizer. To eliminate germs. 4. Clean catheter/tego ends. Make sure both catheter and bloodlines are clamped. Wrap each catheter/bloodline connection with a 4x4-inch gauze soaked in disinfectant. Rub for one minute. Place lines on a dry 4x4-inch gauze. Allow lines to dry for one minute. Clean catheter/tego ends one at a time. INDEPENDENT DIALYSIS PATIENT WORKBOOK 9

10 Instructions cont. 5 Flush and block off catheter lines. a) Check that both catheter and bloodlines are clamped. b) Carefully separate arterial bloodline from arterial line TEGO connector cap. c) Wipe the TEGO connector cap end with an disinfectant-soaked 4x4 gauze and without touching the cleaned end, attach a 10mL prefilled saline syringe. d) Open the arterial line clamp and push through saline. Close clamp and repeat with second 10mL prefilled saline syringe. e) Remove empty syringe and replace with pre-prepared sodium citrate 4% syringe. Open clamp on arterial line and insert sodium citrate 4% or heparin 1000 units/ml (ask your nurse). Clamp arterial line. f) Repeat above steps with the venous catheter line. Related points to note cont. My catheter lines contain. My catheter volume with TEGO is: arterial side ml venous side ml Wrap catheter lines with dry 4x4 gauze and tape. 10 BC PROVINCIAL RENAL AGENCY

11 Changing your dialysis catheter dressing What do you need? 2 clean drapes 1 bottle of disinfectant solution 4 gauze 4x4 s Tape (1 inch) 2 plastic clamps Small garbage bag Face mask Hand sanitizer Dressing (ask your nurse about what dressing is right for you) Why is this important? To keep blood off your table and to keep your surfaces clean. Amuchina may be used as an alternative to chlorohexidine solution. To prevent contamination. INDEPENDENT DIALYSIS PATIENT WORKBOOK 11

12 Instructions 1. Wash your hands for a full minute. Related points to note This initial wash removes oils from your skin. Washing your hands is the best way to prevent infection. 2. Prepare your supplies. a) Half open all 4 (4x4") gauze packages with the bottom paper of the package still intact. b) Apply disinfectant solution (about 10mL of solution) in the centre of 2 gauze packages. c) Open your dressing and place on the drape. d) Clip your second drape on your shirt (if doing dressing change while clothed). e) Put on your mask. It may be helpful to do your dressing in the bathroom after bathing using the mirror. Keeps your clothing clean. 3. Remove old dressing Look for any changes in your skin condition. Is it red? Is there drainage? Is there pain? Report anything unusual to your nurse. 4. Clean hands using hand sanitizer To eliminate germs. 5. Clean site a) Using the soaked gauze, clean catheter site in a circular motion starting closest to the catheter entrance. b) Allow the area to air dry. Moving from cleanest area, next to the catheter entrance, to the less clean area further away helps prevent infection. 12 BC PROVINCIAL RENAL AGENCY

13 6. Attach new dressing a) Peel off backing and attach to skin overlapping about two inches of the catheter under the dressing. Avoid touching the middle part of dressing. b) Wrap lines with dry 4x4 gauze. INDEPENDENT DIALYSIS PATIENT WORKBOOK 13

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