Dialysis catheters are basically artificial indwelling transcutaneous conduits used for accessing the intravascular space for renal replacement therapy necessary for the patients undergoing dialysis. Catheter as the prime function of exchanging from the haemodialysis machine. This procedure involves catheter to be put into patients vein To permit for repeated access to the patients bloodstream. various types of catheters are available used for different dialysis modalities.
The wide spaced central venous lines are used in extra corporeal renal replacement therapy that includes processes like haemodialysis, hemofiltration, haemodiafiltration and ultrafiltration.
The smaller trans abdominal lines are processed for peritoneal dialysis a peritoneal dialysis catheter.
The various kinds of processes requires the different types of dialysis catheters, their implications and contradictions , also the technique involving in dialysis catheter procedures. Before an access to the different types of dialysis catheters, one must consult a nephrologist to provide you the best quality of dialysis treatment. And avoid risk of infection.
Objectives of dialysis catheter procedure
to describe the process to place a haemodialysis catheter in the internal jugular vein.
Review the objections related with different dialysis catheter.
Outline some strategies for the extension of dialysis catheter’s life and also lower the risk of complications
Comment out different absolute and relative contradictions to dialysis catheter.
Besides the mentioned different kinds of catheters, there are also two types of central venous catheter which includes a tunneled and non- tunnled. Donald catheters are meant to be used for longer periods of time whereas the non tunnelled catheter are meant for a temporary use and can we easily put into large vein near your groin, chest or neck.
What should I know before going for the dialysis catheter procedure?
Weight :- Before undergoing for the dialysis catheter procedure, you must obtain an accurate weight measurement, because obesity has been considered a relative contraindication in peritoneal dialysis. this increase is a greater chance of metabolic implications with the excess absorption of carbohydrates, serum amount of triglycerides, abdominal herniation, poor uremic solute Clearance and also peritonitis.
Water intake it is recommended for most of the dialysis patients to control their water intake to 32 ounces per day. instead you should opt for some candies ice chips, frozen fruits generally grapes to avoid drinking too much of water and control your thirst.
Vital signs form a complete set of vital signs and indications . check your blood pressure, must indicate whether it is a hypertension or hypo tension condition. Do avoid your checking blood pressure in the arm using AVF or AVG as it may also cause clothing.
check your temperature.
check your respiration rate and also the quality of respirations.
Check your rhythm of heart as most of the patients undergoing dialysis procedure are more prone to the development of dysrhythmias.
Also obtain the overall condition of the body. Assess your skin, mental status, or check if you are facing any pain or nausea.
Lab results go for the last ordered lab results for better understanding of the situation. review the biochemistry results such as your levels of sodium, potassium, blood urea nitrogen, creatinine, and phosphorus. anticipate these chemicals properly and consult if any of the level is elevated.
Also check your complete blood count, RBC count, haemoglobin and the hematocrit levels.
Scheduled medications after reviewing the list of respected medications, schedule yourself to a 4 hours before the treatment to avoid any type of complication during the treatment.
preparation before dialysis catheter procedure for patients
Equipments
anticipate the working of all the equipments to avoid any complication during the treatment.
Following other requirements preparing before dialysis catheter
- Use local anaesthetic most commonly Lidocaine 1% to 2% using syringe and needle.
- Introducer needle and syringe.
- Skin dilator.
- Skin suture.
- Heparin solution.
- Sterile normal saline.
- Bungs for catheter
- Scalpel.
- Cell ginger guide wire.
Monitor appropriately the ECG blood pressure and pulse oximetry.
Patients should empty their bowels and bladder before proceeding for peritoneal dialysis catheter procedure.
Patient should be placed in Trendelenburg position, head facing forward. however it is not required for femoral vein catheter
The specialist should assess himself in a proper hygienic conditions and equipment.
A sterile drape should be placed on the patient.
During the surgery
The general preparations are
A specialist will clean the abdominal area before incision.
Incision is to be made out in the belly, generally slightly below to the left or right of belly button.
How to take care for a dialysis catheter at home
take a proper care of your catheter so it will last longer and prevent certain complications like clotting and infection to occur. You should also follow some of the important steps to take care of your dialysis catheter at home.
- Always keep the catheter dressing clean and dry. avoid moisture and visiting disturbing places that may cause pollution.
- Care the area of insertion site and make sure that the care team or the clinician changes the dressing at each dialysis session very carefully to avoid any contraindication.
- Try keeping an extra dressing kit at home in case of any kind of emergency or if you need to change your dressing in the duration of treatments. learn the steps how to change dressings from the clinician or the care team so that you can easily perform at home during emergencies.
- Never open the cap off the end of your catheter, you must ensure that air should not enter the catheter.
- Use proper instrumentations for changing the dressings of catheter at home. Do not touch it from hands all the times or in case an infection may happen.
- While opening the catheters try wearing mask over your nose and mouth to prevent bacteria enter catheter and your bloodstream easily. Vera mask as well as gloves to maintain hygienic environment.
- Keep the caps and clamps off your catheter tightly closed when not in use for dialysis. Contact your care team to use your dialysis catheter to drop blood a proceed for any kind of medications if required.
- Contact clinician specialist or the care team if you find any implication in around the area of dialysis catheter such as sores or if it looks like red.
- Must know and investigate your kt/v as well as your URR. This will help you in knowing the amount of palaces you are receiving. Your kt/v should be at least 1.2. and your URR,used it should be 65% or more.
How to take path with dialysis catheter and perma- Cath
before taking bath with your dialysis catheter and perma -Cath , you must consider some precautions or take some appropriate safety to avoid abjections
- If you have a clear dressing that sticks to your catheter site on the skin near around it, then you can take a bath keeping proper precautions. This kind of dressing is actually waterproof that cares well and prevent infections.
- Avoid letting or entering water to your dialysis catheter site during bath. as in touch of water would increase moisture around catheter which can cause some infection.
- Do not open the end of catheter at the time of path as bacteria may enter into it.
- Do not spend much time in the bathroom as it would Moisturise it and would prove to be a bad condition for you.
- You can also take someone’s help during taking a bath to avoid water touch around your dressing side.
- Do not frequently touch your dialysis catheter specially at the time of taking about.
- Do not take a shower or swimming during this time .Instead you can use Washcloth or sponge to clean the body.
- You can wear a waterproof cover over your catheter avoid any moisture entering through it.
How to take care of perma -Cath
Perma- Cath is basically a catheter placed through veins Into. A perma Cath is used for dialysis in an emergency condition or when a long term device is made ready to use. you might feel some pain and swelling near your chest area and neck or you may also press poses two dressings one on your chest and the other one on your neck. after dialysis you may feel some of the symptoms such as fever or fatigue but that’s all casual.
You may also feel light headed, short breath, or some chest pain, For these reasons you may consult your nephrologist.
You must consult a nephrologist or a specialist if any of the following situations occur
- Your catheter becomes wet
- Your bruises get worse
- You feel any kind of fever or chills
- You feel any incision to be red, swollen or draining pus.
You should avoid lifting your right arm.
Lifting you right arm may put a strain on your incision and might cause pain or delay the time of healing. Ask before a specialist the time when you can move for normal activities.
Try keeping dressings dry
Do not get your dressings wet while taking shower or swimming as it would moisturise the dressing and could inculcate the growth of bacteria and simultaneously an infection. in case, your dressing become wet, dry it off and cover it with a dry sterile gauze. Avoid using soaps or ointments.
Do not change your dressings casually
Do not change your dressing on your own until and unless your healthcare provider suggests you to do so. keep your dressings in place and it would be better if your healthcare provider changes it properly. the dressing lying on your chest will be there as long as the catheter is positioned in its place.
Do not open the red and the blue caps from the end of your catheter
The caps of catheter prevents entering air into your catheter and also the various kinds of bacteria or infection to occur. it protects the catheter.
When to get dialysis catheter dressing change
Dialysis catheter dressing should maintain sterility. the most recent CDC guidelines suggests that goes dressings should be changed every 48 hours add transparent semipermeable dressings every seven days that is after every week.
The frequency of dressing change varies from 2 to 15 days or even early if there is any complication spotted.
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