POLICY
Hemodialysis and Plasmapheresis catheters are not to be used for routine administration of parenteral solutions. An exception may be made in SPECIAL CIRCUMSTANCES as determined by the physician. Approval must be obtained from the nephrologist.
PROCEDURE – Quinton and Ash Catheter
Before initial use of the catheter verify with the physician that the tip of the catheter is placed centrally. A Xray read by a MD or fluoroscopy placement by a radiologist must have been done to verify correct tip placement.
1. Obtain and review physician’s orders. (Order must state nephrologist has approved)
2. Check for any drug allergies. If patient is allergic to iodine, request an order from the nephrologist to use a cleansing solution to replace betadine used in this procedure.
3. Order must include:
- Medication to be infused, dose, volume, rate
- Volume and dose of heparin flush.
Volume will vary per catheter type. See catheter lumen, and confirm heparin order with the nephrologist. (Example: Quinton “V” lumen marked 1.6 = 1.6 cc of heparin 5,000 units/cc to lock catheter lumen)
4. Wash hands.
5. Assemble equipment.
- 5 to 6 packages of sterile 4″X4″gauze
- 1 mask for nurse, 1 mask for patient (if applicable)
- Betadine solution
- 1- 10cc syringe
- 1- 10cc syringe filled with 10cc of 0.9% normal saline
- 1- sterile red cap/infusion plug
- Intermittent IV medication, and/or IV hydration solution as ordered
- IV tubing
- Plum pump
6. Set up pump.
If the patient is to have a continuous hydration infusion: Set up the Plum pump set with the continuous fluid as the primary line and the drug to be administered as the secondary line. This provides for the conversion to the continuous hydration fluid as the drug is completed.
7. Don mask and clean gloves. Apply mask to patient, or alternatively have patient turn head facing away from catheter insertion site.
8. Don other Personal Protective Equipment as appropriate (example: pull back long hair or wear under cap, goggles)
9. Use aseptic technique and observe Standard Precautions, and other applicable precautions throughout procedure.
10. Use one dedicated lumen for the infusion. Use the lumen marked “V” on the Quinton catheter, and verify with MD which lumen to use on the Ash catheter.
11. THESE CATHETERS ARE HEPLOCKED WITH HIGH DOSE HEPARIN. NEVER FLUSH A HEPLOCKED CATHETER LUMEN BEFORE DRAWING OFF THE 5cc DISCARD BLOOD.
12. Remove gauze at catheter hub and clamp area. Do not remove dressing over the catheter insertion site. (Dressings over the insertion site of the catheter are removed and changed by the dialysis/pheresis RN only.)
13. Saturate one package of 4″X4″ gauze in betadine. Wrap betadine gauze around catheter hub/cap connection, and wrap 2 or more dry sterile 4″X4″ gauze as padding around the betadine gauze. Place blue pad underneath.
Scrub hub/cap connection with betadine gauze and allow hub/cap connection to soak in betadine gauze for 3 to 5 minutes and allow hub/cap connection to dry before removal of cap.
14. Ensure the catheter lumen is clamped and remove the end cap/infusion plug. Hold sterile 4″X4″ gauze under hub/ catheter end during all connections.
15. Attach the 10cc syringe, unclamp the catheter and aspirate 5cc of discard blood. Clamp the catheter.
16. Attach the saline filled syringe. Unclamp the catheter. Flush the catheter with 10cc 0.9% normal saline. Clamp the catheter.
17. Connect primed medication (or hydration) IV tubing, unclamp the catheter and infuse medication as ordered via the Plum pump.
If the drug is to be infused as the secondary line, the y port must be scrubbed with betadine and allowed to dry for 2 minutes prior to connecting the medication tubing to the y port.
18. Cover catheter tubing connection area with sterile 4″X4″ gauze pads. Tape gauze in place. Avoid tape on the catheter.
19. Complete infusion as ordered.
20. 3 to 5 minutes prior to primary infusion completion, cleanse/scrub catheter/tubing connection with a betadine soaked gauze and allow catheter/ tubing connection to dry as in step #12.
21. Clamp the catheter. Hold 2 sterile 4″X4″ gauze as padding under hub/catheter during all connections. Remove the primary IV tubing from the catheter.
22. Flush the catheter with 10cc 0.9% normal saline. Clamp the catheter.
23. Flush the catheter with heparin at the specific concentration and volume as marked on the catheter lumen and as ordered by the nephrologist. Clamp the catheter.
24. Cap the catheter with a sterile red cap/infusion plug.
25. Cover the catheter hub and clamp area with sterile gauze and tape or apply a rubber band to hold gauze in place. Avoid tape on the catheter.
REFERENCES:
- Policies and Procedures for Infusion Nursing (Infusion Nurses Society (INS)Clinical Practice Committee, 2000)
- National Kidney Foundation- Dialysis Outcome Quality Initiative Guidelines (2001- per National Association of Vascular Access Networks (NAVAN) Resource Guide)