Hemodialysis catheters - Frequently asked questions (FAQs)

Dialysis Nurse Manager Questions:

Implanter Questions:

Patient Questions:


 

Question

What is Arrow’s recommended catheter site care protocol?

Answer

Arrow follows the Centers for Disease Control guidelines for proper catheter site care. The CDC recommends that either sterile gauze or sterile, transparent, semi-permeable dressing be used to cover the catheter site. Tunneled CVC sites that are well healed might not require dressings. If the patient is diaphoretic, or if the site is bleeding or oozing, gauze dressing is preferable to a transparent, semi-permeable dressing. If the catheter-site dressing becomes damp, loosened, or visibly soiled it should be replaced. The CDC guidelines specify that topical antibiotic ointment or creams not be used on insertion sites (except when using dialysis catheters) because of their potential to promote fungal infections and antimicrobial resistance. Also, the CDC recommends that the catheter not be submerged under water. Click here to see additional site care instructions and recommendations on antiseptics used for catheter site care.

For more information on guidelines for vascular access, please reference K/DOQI guideline #15 at http://www.kidney.org/professionals/kdoqi/guidelines and for more information regarding catheter site care visit the CDC website at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

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Question

What is the recommendation for catheter dressing change?

Answer

The CDC recommends that the catheter dressing be changed when it becomes damp, loosened, soiled, or when inspection of the site is necessary. Dressings on short-term CVC sites should be replaced every 2 days for gauze dressings and at least every 7 days for transparent dressings, except in those pediatric patients in whom the risk for dislodging the catheter outweighs the benefit of changing the dressing. Dressings used on tunneled or implanted CVC sites should not be replaced more than once per week, until the insertion site has healed. For more information on this information and similar guidelines, please visit the CDC’s website at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

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Question

What is the flush recommendation for the Cannon Catheter™?

Answer

Every 48 hours, but no longer than 72 hours.

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Question

What are the Cannon Catheter flow rates and pressures?

Answer
Flow rate (cc/min) Arterial Pressure (mmHg) Venous Pressure (mmHg)

100

-20

20

200

-40

35

300

-65

55

400

-105

80

500

-145

105

 

 

 

 

*In vitro test performed by an independent laboratory (Citech, Plymouth Meeting, PA)

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Question

What is the priming volume for my catheter?

Answer

It is total volume per lumen including the extension lines. This information is printed on the catheter extension lines. The priming volumes for the Cannon Catheters are as follows:

Cannon Catheter™ Number Venous Arterial
Cannon II Cannon II Plus

CS-15242

CS-15242-SP

2.2 cc

2.0 cc

CS-15282

CS-15282-SP

2.4 cc

2.2 cc

CS-15322

CS-15322-SP

2.6 cc

2.4 cc

CS-15362

CS-15362-SP

2.8 cc

2.6 cc

CS-15552

CS-15552-SP

3.6 cc

3.4 cc

 

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Question

How would I determine the accurate priming volume for the Cannon Catheter after the hub has been replaced or the catheter has been trimmed at some point other than the cut line?

Answer

If the catheter is cut at some point other than the cut line, the priming volume will need to be adjusted. For every centimeter cut away from the trim line, the priming volume changes by 0.13 cc. To determine the new priming volume for each 1 cm the catheter is trimmed proximally (towards the catheter hub) from the trim line, the arterial and venous priming volumes should be increased by 0.13 cc. For each 1 cm the catheter is trimmed distally (away from the catheter hub) from the trim line, the arterial and venous priming volumes should be decreased by 0.13 cc.

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Question

How often should the Luer caps be changed on the Cannon Catheter?

Answer

Every 7 days or as necessary.

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Question

What is Arrow’s recommended protocol for catheter heparinization and recommended heparin concentration?

Answer

To maintain patency of the catheter between treatments, a heparin lock is usually created in each lumen of the catheter. The concentration of heparin, or alternative anticoagulant, should be determined by hospital protocol or physician order. If the catheter will not be used, it is recommended that the catheter be flushed and re-locked, usually every 48 hours, but no longer than 72 hours. Prior to flushing the catheter, first aspirate out existing lock solution, then flush catheter with saline or as per facility protocol.

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Question

What strength of heparin can be used on the Cannon Catheter?

Answer

10 units/cc to 1,000 units/cc has been found to be effective. However, it is best to check with the respective physician or hospital protocol. Dialysis catheters are typically flushed with 1,000 units/cc to 5,000 units/cc of heparin.

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Question

What is the recommended treatment for thrombotic occlusions within the Cannon Catheter?

Answer

The physician or hospital protocol will ultimately decide what agent to use for chronic catheters, however the Cathflo® Activase® has been proven to restore function to central venous access devices as assessed by the ability to withdraw blood.

Click on the following link for more Activase® details: http://www.cathflo.com.

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Question

Do any of the Cannon Catheter sets contain latex?

Answer

No. The catheter and its components are latex-free.

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Question

Is the Cannon Catheter MRI safe?

Answer

Yes. The Cannon Catheter presents no additional risks to the patient or other individuals during use with shielded magnetic resonance (MR) systems up to 3.0-Tesla, but may produce some MR imaging artifact in the area of the device. As always, the clinician should follow hospital protocol when making decisions regarding compatibility. For a more detailed discussion on MRI safety the following websites are listed for your convenience:

www.fda.gov/cdrh/ode/primerf6.html
www.radiologyinfo.org/content/safety/mri_safety.htm
www.mrisafety.com

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Question

How soon after catheter placement can a MRI procedure be done?

Answer

Immediately.

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Question

Is the Cannon Catheter radiopaque?

Answer

Yes. The catheter contains a Barium Sulfate filler which makes it visible under fluoroscopy and on chest x-ray.

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Question

What are the indications for use for the Cannon Catheter?

Answer

For attaining long-term vascular access for Hemodialysis and Apheresis. The Cannon Catheter is inserted percutaneously and is preferentially placed into the internal jugular (IJ) vein. Alternately, this catheter may be inserted into the subclavian vein, although the jugular vein is the preferred site. Catheters greater than 40 cm are intended for femoral vein insertion. The Cannon Catheter is intended for use in adult patients.

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Question

How soon after a catheter is placed can it be used?

Answer

As soon as proper tip location is verified and the inserting physician writes a prescription for catheter use.

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Question

Can the Cannon Catheter be used in pediatric patients?

Answer

No. The Cannon Catheter is indicated for adult patients only.

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Question

What are the CPT codes for chronic hemodialysis procedures?

Answer

Consult your payor organizations with regard to local coverage, bundling requirements, and reimbursement policies.

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Question

What happens if I forget to use the green compression sleeve during the catheter assembly process?

Answer

The green compression sleeve MUST be present when threading compression cap onto hub connection assembly. Failure to do so may result in air embolism, blood loss, or catheter separation.

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Question

What syringe size is recommended for use with the Cannon Catheter?

Answer

It is recommended that a 10cc or larger syringe be used to infuse or flush the catheter. Infusion pressures should never exceed 40 psi to prevent damage to blood vessels. A two-pound weight equivalent force on the barrel of a 3cc syringe generates pressure in excess of 40 psi. The same two-pound weight equivalent force on the barrel of a 10cc syringe generates less than 8 psi of pressure.

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Question

Can the Cannon Catheter be re-sterilized?

Answer

No. Arrow products are for single use only.

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Question

Can the Cannon Catheter be used in the Radiology department with a power injector?

Answer

The Cannon Catheter has not been evaluated for use with Power Injectors.

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Question

What is a chronic hemodialysis catheter?

Answer

A chronic hemodialysis catheter is designed to remain in place for an extended period of time, allowing vascular access for dialysis. Benefits of this catheter include the dialysis nurse’s ability to start dialysis through the catheter rather than using a graft or fistula in the patient’s arm. Also, a chronic hemodialysis catheter provides a vascular access in patients who cannot have or do not want fistulas or grafts due to their medical condition.

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Question

Where are hemodialysis catheters placed?

Answer

Typically they are placed into a large vein in the neck. The Cannon Catheter can also be placed into a vein in the upper chest or the groin.

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Question

How do I take care of my catheter?

Answer

Here are a few recommendations for catheter care:

  • Keep surgical sites clean and dry until they are completely healed.
  • Keep exit sites clean and dry for at least 6-8 weeks.
  • If you experience any pain, redness, or swelling at the exit site of the catheter, immediately notify your doctor and dialysis nurse.
  • Do not pinch, poke, bend, or pull at your catheter.
  • Do not use sharp objects around your catheter.
  • Do not get your catheter wet (shower, swimming, soaking while bathing) until you have permission from your doctor.

When in doubt, ask your doctor or your dialysis nurse for advice.

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Question

What should I do if my catheter falls out or breaks?

Answer

Apply pressure to the site and immediately contact your physician and seek emergency medical attention.

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Question

Can I shower or swim with my Cannon Catheter?

Answer

The CDC recommends that the catheter not be submerged under water, and it is not recommended to swim, shower, or soak catheter dressings while bathing. Contact your physician for additional recommendations.

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Question

Is a tanning salon harmful to my catheter?

Answer

Yes. The UVA rays will degrade the catheter’s material.

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Question

What should be done if my catheter behaves differently?

Answer

Tell your doctor right away. He or she will tell you if there is a problem.

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Question

What should be done if I have no blood return in my catheter?

Answer

Tell your physician as soon as possible. Loss of blood return can mean there is a problem with the catheter.

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Question

What are the K/DOQI guidelines?

Answer

The K/DOQI (Kidney Disease Outcomes Quality Initiative) guidelines are a program of the National Kidney Foundation, outlining clinical practice guidelines for chronic kidney disease.

http://www.kidney.org/professionals/kdoqi/

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