Dr.Mohammed Wahba Lecturer of internal medicine and nephrology MNDU.NET

1. Brief pathway to handle
temporary HD catheter
Mohammed Wahba
Lecturer of internal medicine and
nephrology
MNDU.NET

3. Agenda:
o Indications of temporary HD catheter.
o Types of temporary HD catheters.
o Precautions before insertion.
o Some comments on insertion.
o Care after insertion (doctor, nurse and patient)
o Common complications and how to interfere with
them.
o Home message.

4. Indications of temporary HD catheter:
• AKI
• Bridge to renal transplantation.
• ESRD and with following conditions:
o AVF not ready and patient is indicated for HD.
o Complicated AVF.
o Contraindications for AVF.

5. Types of temporary HD catheters:

6. Types of temporary HD catheters:

7. Types of temporary HD catheters:

8. Precautions before insertion:
• Adequate documentation of care/ competency of
operator.
• Revision of infection control precautions and
bleeding pathway.
• Optimal catheter type and site of insertion
selection.

9. Anatomic varieties of IJ & Rt femoral v.

10. Selected factors favoring different temporary (non-tunneled) hemodialysis catheter
insertion sites
Right internal jugular site
Critically ill and bed-bound with body mass index >28
Postoperative aortic aneurysm repair
Ambulatory patient/mobility required for rehabilitation
Femoral sites
Critically ill and bed-bound with body mass index <24
Tracheostomy present or planned in near-term
Need for long-term hemodialysis access present, highly likely or planned
Emergency dialysis required plus inexperienced operator and/or no access to ultrasound
Left internal jugular site
Contraindications to right internal jugular and femoral sites
Subclavian sites
Contraindications to internal jugular and femoral sites
Right side to be used preferentially

11. Some comments during insertion
• Benefits of US guided insertion in both IJ and femoral
access.
• Confirmation of guide wire removal.
• Sharps management.
• Dressing.
• Catheter locking (citrate vs heparin, use of local ab & TPA)

12. Care after insertion:
• Hand hygiene.
• Exit site dressing.
• Nasal mupirocin 2%.
• Replacement of unnecessary catheter.
• Instructions to patient.
• Preferred time to remove temporary catheter.

13. Complications of temporary catheters:

14. Some definitions:
• Catheter mechanical dysfunction was defined as inability to achieve
blood flow rate of >250 mL/min or high blood pump pressures despite
attempts to improve flow such as patient repositioning or reversal of
catheter lumen
• Definite CRB was defined as fever with temperature >38°C with
isolation of identical micro-organism from cultures of blood and
catheter tip and no other obvious focus of infection.
• Possible CRB was defined as fever with temperature >38°C and no
other obvious focus of infection and where the microbiological criteria
were insufficient to make a diagnosis of definite CRB.
• Exit site infection was defined as the development of cellulitis or
purulent discharge at the site of catheter insertion.

16. How to deal with catheter infection?
o When suspected CRB (culture, salvage pathway, treatment).
o Choice of empirical ab : combination of
• Vancomycin plus
o Meropenem, imipenem or etrapenem.
o Gentamicin
o Pipracillin/tazobactam
o fluconazole
o Confirmed infection (culture, removal, duration of ttt)
• Metastatic complications 4-6 ws
• Staph. Aureus &MDR bacilli more than 14 ds.
• Enterococci 7-14 ds.
• Candida 14 ds since last negative culture.
• Uncomplicated 7 days only.

17. Home message:
• AVF is the preferred venous access to ESRD who are
expected to have HD unless contraindicated.
• When expected to have HD more than 3 ws, cuffed
tunneled HD catheter is the preferred.
• In AKI, tunneled is better than NTHDC.
• Follow bundle for care and maintenance of HD catheter.
• Don’t miss the role of nursing and patient.