DEFINITION
Temporary vascular access is used for the patient who has no functioning permanent arterovenous access. This includes acute and chronic patients requiring haemodialysis or other renal replacement therapy for SVC, JVC & FVC and permcath.
PURPOSE
Provide temporary access to the venous circulation for the purposes of undertaking haemodialysis and / or other form of extracorporeal renal replacement therapy / or treatment.
CONDITIONS
1. Applies to all Registered Nursing Personnel working in dialysis centers in Oman.
2. This procedure can be performed by a dialysis nurse undertaking nephrology / hemodialysis training program, provided he / she is closely supervised by an experienced dialysis nurse at all times
3. Two (2) nurses, of whom one should be an experienced haemodialysis nurse, should carry out this procedure
4. A strict aseptic technique should be maintained throughout the procedure in accordance with the policy and procedure on aseptic technique.
5. Hand washing should be performed according to policy and procedure on aseptic hand washing.
6. The catheter dressing must be changed at every dialysis session
7. The catheter should be filled with heparin, when not in use. The concentration is 5000 i.u./ml, volume (capacity) and the amount used is according to the catheter volume (capacity) as per manufacturer’s instruction
8. Avoid talking throughout the procedure to minimize infection
EQUIPMENT
1. Haemodialysis log
2. On and off pack
3. Sterile gloves x 2 , Unsterile gloves 2
4. Syringes 10 x 1 (if blood samples is required)
5. Syringes 10ml x 2 (for removing previous heparin lock)
6. syringes 1ml or 20ml x1 (optional ) in anticipated flow problem
7. Syringes 10ml x 1 (for heparin loading dose)
8. Heparin for loading dose (use Heparin 1000 i.u./ml vial)
9. Trolley / bed sid table cleaned according to infection control policy and procedure
- Betadine antiseptic solution
- Surgical mask
Alert Do not use alcohol for cleaning
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Check the dialysis prescription | To obtain specific instructions for the management of the patient. |
| 02 | Identify the patient. Ensure that patient is wearing identification bracelet with correct information. (if patient is admitted in the hospital) | To fulfill legal requirements and hospital policy |
| 03 | Explain the procedure to the patient and allow him to ask questions. | To allay fears and gain patients confidence and co-operation. To promote patient education. |
| 04 | Ensure privacy | To avoid unnecessary embarrassment to the patient during the procedure |
| 05 | Complete pre haemodialysis assessment (refer to policy and procedures on Pre-dialysis assessment). | To ensure patient is fit for haemodialysis. |
| 06 | Wash and dry hands (refer to policy and procedure on infection control). | To prevent cross infection. |
| 07 | Prepare on/off pack with all accessories. | |
| 08 | Don Unsterile Gloves By 2ND Nurse and remove dressings and tapes from the catheter. DO NOT USE SCISSORS. | To prevent cross infection To avoid damage to the catheter. |
| 09 | Inspect exit site for signs of infection. Take swab for culture and sensitivity if indicated. | To detect early signs of infection. |
| SN | Nursing Action | Rationale |
| 10 | Wash hands with disinfectant (preferably hibiscrub or betadine). Dry hands with sterile towels. Wear mask | To prevent cross infection. |
| 11 | Wear sterile gloves. | To prevent cross infection. |
| 12 | Place sterile field under catheter. Take gauze, soaked with betadine, and place around `A’ and `V’ caps and extensions and with gentle scrubbing clean for three minutes. | To prevent infection. |
| 13 | Clean exit site with cotton balls soaked in betadine then cover with sterile gauze until treatment is completed. Remove gloves and don anthor sterile gloves. Place another deapr under the catheter and secure with sterile plaster. | To clean and sterilize exit site. To prevent accidantal falling of sterile field |
| 14 | Ensure that the extensions are clamped before removing the luer lock caps. | To prevent air entry and blood leak. |
| 15 | Attach syringe to `A’ side, open clamp, aspirate 2mls, clamp the `A’ side again and flush the contents on a piece of gauze. Keep loading heparine ready | To remove priming heparin and check for blood clots. |
| 16 | If there is significant clotting, then remove 3 – 5 mls more blood and check for more clots. | To ensure adequate blood flow for haemodialysis. If not seek medical advice. |
| 17 | Assess blood flow in `A’ by using 10ml syringe filled with normal saline (2-3 mls). | |
| 18 | Flush lumen with normal saline (take blood samples prior to this process when required). | |
| 19 | Repeat the steps 14 – 17 for venous side. | |
| 20 | Administer the loading dose of heparin via the venous lumen. | To heparinize the blood. |
| SN | Nursing Action | Rationale |
| 21 | Initiate dialysis as usual, secure catheter and dialysis lines to ensure there is no traction on the catheter from hanging bloodlines. | To avoid accidental pulling out of catheter. |