Dialysis Services at Guthrie

Dialysis Catheter Care

The primary types of dialysis accesses used at Robert Packer Hospital include temporary vascular catheter, Permcath® catheter, Tesio® catheter, arteriovenous fistula, arteriovenous graft and peritoneal catheter (PD catheter or Tenchkoff catheter).

Temporary Catheters

The catheter that is used on a short term basis (usually for <3 weeks) is called a double- lumen catheter, manufactured by Quinton or Arrow. It is one catheter with two openings called lumens, so that blood can be taken out to be cleaned and returned through the other side of the catheter. This catheter is usually inserted through a vein in the side of the neck. It is stitched in place where it enters your neck and covered with a sterile dressing to keep it clean and free from infection.

Long-Term Catheters

The other types of vascular catheters for dialysis are used on more long-term basis, usually six months or more. Your physician and nurses will be referring to these catheters as permanent or tunneled catheters.

CONTACT YOUR DOCTOR OR DIALYSIS NURSE IMMEDIATELY IF YOU NOTICE ANY OF THE FOLLOWING:

Any drainage, redness, swelling or pain around the exit site
Any visible change in the exit site
If you experience chills or fever

What problems can occur with the dialysis vascular catheter?

INFECTION

SIGNS: You may experience any or all of the following: fever, chills, drainage, redness or tenderness at the catheter exit site or insertion incision on your neck. You may also feel unusually tired or run down, or experience nausea and vomiting.

What to do: Call your doctor or dialysis unit immediately. You may have an infection and need an antibiotic to prevent the spread of infection into your blood which can be life threatening.

BLEEDING FROM THE CATHETER

SIGNS: Blood leaking from the catheter

What to do: Stop the bleeding by pinching, clamping, or tying off the end of your catheter. Go to the nearest Emergency Room for help and inform your dialysis unit as soon as possible.

CLOTTED CATHETER

Signs: No blood return when the nurse tries to start dialysis.

What to do: Your nurse will be able to take care of this problem in the dialysis unit prior to starting dialysis. Sometimes a medicine that dissolves blood clots can be injected to remove the clot. If this does work then other measures may need to be followed.

AIR IN THE LUNG (PNEUMOTHORAX)

Signs: Shortness of breath or chest discomfort within hours after the catheter is inserted, this means air may have entered your lungs when the catheter was being inserted.

What to do: This is an EMERGENCY. Call 911 and sit quietly in a position that is comfortable. You will need to be seen as soon as possible.

AIR IN THE CATHETER

Signs: This may occur if the catheter is cut or the cap is removed accidentally. If this occurs you may experience shortness of breath, chest pain or pass out.

What to do: Make sure that the caps are in place and there are no sharp objects around your catheter at all times. Check your catheter periodically throughout the day to make sure that it is not damaged and the caps are in place. If you experience any of the above mentioned signs, this is an EMERGENCY. Clamp the catheter immediately near the exit site if the catheter has been damaged or the cap has come off. If the damage to the catheter is between the clamp and your skin, then tie a knot in the catheter close to where the catheter enters your skin. You may also bend the catheter over and hold it closed by tightly placing a rubber band or plastic twist tie around the bent catheter. Lie down on your left side with your head down and your feet elevated. Call 911 for help and notify the dialysis unit when you are able.

SWELLING OF THE NECK, ARM OR HAND ON THE CATHETER SIDE

Signs: Sometimes the vein in your neck becomes narrowed when the catheter is in place. If you notice swelling in your hand, arm, neck or breast this may be the problem.

What to do: Let your dialysis nurse know when you came for your next dialysis treatment. They will notify your doctor and he may want to get a special tests to evaluate the situation.

CALL 911 IMMEDIATELY IF AT ANY TIME YOU HAVE UNCONTROLLED BLEEDING. SHORTNESS OF BREATH OR CHEST PAIN

What is a peritoneal dialysis catheter?

A peritoneal dialysis catheter is necessary to perform peritoneal dialysis. Peritoneal dialysis is the filtering of waste products from the blood using the peritoneal membrane as the semi-permeable membrane. The catheter is inserted in the operating room by a doctor using a local anesthetic to remove sensation from the abdomen. The catheter will allow the solution (called dianeal) to be infused into the peritoneal cavity. Waste products will pass from the blood through the peritoneal membrane and into the dianeal in the peritoneal cavity. After a 3-6 hour dwell time, the used dianeal (called effluent) will be drained from the cavity via the catheter and be replaced with a new bag.

Care of the peritoneal dialysis catheter prior to starting dialysis

The dressing that you go home with after the catheter is inserted remains in place for 8-10 days. Arrangements will be made for you to return in 8-10 days to perform a sterile dressing change. If you notice the tape coming loose, you can put more tape on the dressing to prevent it from falling off. You may not shower or tub bathe, but are allowed to sponge bathe, making sure to keep the dressing dry. You will need to be careful not to strain your stomach muscles and should NOT lift anything over ten pounds.

If the dressing becomes soaked with blood you will need to be seen immediately. In an emergency, you should go to the nearest emergency room. If the drainage is a small amount (for example the size of a fifty-cent piece) and is pink to light red in color, call the dialysis unit to notify the nurses.

A portion of the catheter will be outside the body but hidden by your clothes. This portion will not be visible to you until you do the dressing changes in the beginning. After the stitches are removed there will no longer be need for a large bandage and you will be able to wear a dressing just over the exit site, the area where the catheter "exits" or comes out of the abdomen.

Peritoneal Catheter Daily Care

This catheter care is to be done after the stitches are removed from the incision and the exit site of the catheter is completely healed.

SUPPLIES:

Wash cloth with mild soap and water
Betadine Swabstiks
Gauze Sponges
Tape

PROCEDURE:

Remove old dressing.
Look at catheter exit site for signs of infection or irritation.
Wash site with soap wand warm water making a good lather. This is done to remove old Betadine, increase circulation to area and wash Betadine Swabstiks, gently wipe around the exit site. Begin next to the catheter and wipe in half circles for 2-4 inches in diameter, moving away from the exit site. By wiping from the catheter site outward, the skin bacteria are wiped away from the exit site.
Allow the bacteria from skin.
With the Betadine to dry completely around the catheter before applying the dressing.
Place gauze sponges around the exit site and tape to the abdomen.
The catheter should be positioned clockwise around the exit site. Changing positions of the catheter and sites of tape will help to make sure the tissue grows around the catheter and helps to heal the area.
Once the exit site is completely healed it may not be necessary to wear a dressing around the exit site, but it will still be important to clean around the catheter every day with soap and water and to also apply Betadine.

Points to Remember:

Notify the dialysis unit of any changes in the exit site or incision.
Notify the dialysis unit if there is any:

a. Redness

b. Swelling

c. Pain or tenderness

d. Drainage from or around the catheter site.
DO NOT FORCEFULLY REMOVE CRUSTS from around catheter. Vigorous removal of crusts may cause bleeding and possible breakdown of the skin leading to infection.
Proper daily care of your catheter will help lengthen the life of your catheter. To do peritoneal dialysis it is important that your catheter works properly and is free from infection.
DO NOT swim in rivers, ponds, lakes, oceans, hot tubs or Jacuzzi’s. Remember to only swim in chlorinated swimming pools and to do catheter exit site care IMMEDIATELY after getting out of the pool.
Clean the catheter exit site every day, and when the area or dressing becomes dirty or after swimming.

Do’s and Don’ts of Catheter Care

Do’s:

Do keep surgical sites clean and dry until they are completely healed.
Keep sites clean and dry for at least 6 weeks or until your doctor tells you differently.

If you have a temporary catheter you will not be able to swim or shower as long as you have this catheter in place. You will however, be able to swim and shower with the Permcath® or Tesio® catheter.

Do tell your doctor and dialysis nurse immediately if you have pain, redness, drainage or swelling at the exit site of the catheter.

Don’ts:

Don’t pinch, bend or pull at your catheter.
Don’t use sharp objects around your catheter.
Don’t get you catheter wet (shower, swimming) until you check with your doctor. As already mentioned, you will not be able to shower or swim with a temporary catheter.