The Procedure For Catheter Patients.

                In the last post I explained the procedure of haemodialysis. But when it comes to the starting and closing of the catheter patients, it’s a bit different. It needs more care and patience as there is a higher risk of infection for catheter patients.  The procedure remains the same till priming. After that, remove the protective covering of the catheter with the gloves we primed the dialysis set. Then remove it and don a pair of new sterile gloves. Ask the assistant to open the outer flap of the autoclaved tray. Then open the tray and ask your assistant to open and transfer all the packaged articles to it. Wet a sterile cotton ball with spirit and povidone iodine and wipe the catheter and the portion of the skin to which the catheters come in contact with.  Uncap the catheter and wipe the catheter from the opening towards the other end. Place a sterilized towel under the catheter and withdraw 2-3 ml of blood from each tube using a 5ml syringe. This is to minimize the risk of infection and thromboembolism and to avoid the mixing of old flushed heparin with the blood.  The tubes of the catheter will be of two colours- red, arterial and the blue, venous.  Ensure the free flow of blood in the catheter by repeated aspirations followed by reinfusions.  In some patients, due to careless handling and bending, the catheters may get dislodged or kinked. In such cases, we have to carefully adjust the catheter position manually or try massaging the vicinal part of the catheter insertion.  After a free flow of blood is established, connect the blood lines accordingly and run the pump at a slow rate.

                                                                          After the blood is returned at the end of the dialysis, flush the catheter thoroughly until the transparent tubes become completely clear. Then we have to do hep-locking(1ml of 25000IU heparin diluted with 5ml saline. Some entertain choosing sodium bicarbonate injection instead of normal saline. According to me, it is more preferable. This is to prevent the formation of clots until next dialysis. For some people who frequently get infections, we close the catheter with antibiotics like gentamycin or amikacin. After the flushing is complete, clean the catheter tip with betadine and spirit. No blood or clot should be allowed to remain. Close it tightly with a cap, then repeat  wiping over the entire catheter 2 or 3 times with new swabs. Cover the catheter with a sterile gauze and then by a clean adhesive plaster. Remove the plaster over the catheter insertion site for cleaning. Remove the old gloves and don the new ones. Clean the insertion site thoroughly and most importantly carefully using gauze dipped in betadine and spirit. Repeat twice and move towards periphery. Remember, once you move towards periphery; don’t come back to the insertion site. After drying the site, cover it with sterile gauze then secure with a clean plaster. That’s all….