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Note: Each lumen should be completely filled with heparin to
ensure effectiveness.
7.
Close extension clamps.
Caution: Extension clamps should only be open for aspiration,
flushing, and dialysis treatment.
8.
Remove syringes.
9.
Attach a sterile end cap onto the female luers of the extensions.
•
In most instances, no further heparin is necessary for 48-72
hours, provided the lumens have not been aspirated or flushed.
•
Clean skin around catheter. Chlorhexidine gluconate solutions
are recommended; however, iodine-based solutions can also be
used.
•
Cover the exit site with occlusive dressing and leave extensions,
clamps, and caps exposed for access by staff.
•
Wound dressings must be kept clean and dry.
Caution: Patients must not swim, shower, or soak dressing while
bathing.
•
If profuse perspiration or accidental wetting compromises
adhesion of dressing, the medical or nursing staff must change
the dressing under sterile conditions.
Caution: Always review hospital or unit protocol, potential
complications and their treatment, warnings, and precautions prior
to undertaking any type of mechanical or chemical intervention in
response to catheter performance problems.
Warning: Only a physician familiar with the appropriate techniques
should attempt the following procedures.
INSUFFICIENT FLOWS:
The following may cause insufficient blood flows:
•
Occluded arterial holes due to clotting or fibrin sheath.
•
Occlusion of the arterial side holes due to contact with vein
wall.
Solutions include:
•
Chemical intervention utilizing a thrombolytic agent.
MANAGEMENT OF ONE-WAY OBSTRUCTIONS:
One-way obstructions exist when a lumen can be flushed easily but
blood cannot be aspirated. This is usually caused by tip
malposition.
One of the following adjustments may resolve the obstruction:
•
Reposition catheter.
•
Reposition patient.
•
Have patient cough.
•
Provided there is no resistance, flush the catheter vigorously
with sterile normal saline to try to move the tip away from the
vessel wall.
SITE CARE
CATHETER PERFORMANCE
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