I have this really weird anxiousness around central line hemodialysis catheters. 

I can’t really explain the immense fear I have of them.  Perhaps it was due to this one nurse when I first started who stuck her hand in my face and told me to never ever ever touch a catheter, this was after I glanced at it sideways.

I understand where she was coming from, I do, I really do.  But now that I am allowed to access them and touch them and pull blood out of them and clean the insertion site, I get immensely sweaty and feel the need to vomit a little.

There is also the small problem that every time I go into work I have a different person telling me how to do it “properly”.  So I spent half my thought process thinking about how this one nurse likes to place a sterile 2×2 under the pigtails and how the other says that’s wrong and we must place a sterile 4×4.

God help me.

From now on, I am following the Policy and Procedure which does not specify the size of sterile gauze and I don’t wanna hear any more about it. 

I am sticking the stethoscope in my ears and humming into the bell, you may all disperse, leave Kim alone.


~ by Kim on October 14, 2008.

4 Responses to “Fear”

  1. I don’t use a sterile gauze at all. Pick up the pigtail with your non-dominant hand and don’t let go of it until you have aspirated and flushed the port. It means having everything ready and open so you can manage one-handed. Soak and scrub the caps first. 3cc syringe, aspirate, 10cc of saline, flush, then do the other port. Leave the flush syringe on to maintain sterility until you are ready to hook up the line. Do your dressing change while the caps are soaking. If you don’t have a place to set up your supplies put a clean drape in the patient’s lap. Do you know how to open the wrapper on a syringe, fill it, and put it back into the wrapper while keeping the tip and the inside of the wrapper sterile?

    BUT. . .if your P &P says to lay it on a sterile gauze, use a 4×4. Your sterile area is larger. Any you and the patient should both wear masks, a face shield is not good enough.

    When you put in the heparin lock, draw up 0.1ml more than the fill volume calls for and pop it in. Don’t push it slow. Slow pushing dilutes the heparin at the end of the catheter and contributes to clots. The extra volume makes sure the lock solution gets all the way to the tip of the lumen.

    Now that I have added to the confusion I’ll shut up.

  2. Actually that was pretty helpful.

  3. not an HD nurse.

    I think the main idea is to stick to the sterile technique.

  4. When taking care of CRRT patients we have a whole handout on catheter are as well as set up and take down procedures.
    I agree it’s all about sterile techniques and what supplies are being used.

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