How To Care For Dialysis Catheters?

Introduction

Dialysis catheters are used to drain a patient's blood to a dialysis machine for processing, and then return the processed blood to the patient.

Long-term catheter use may lead to a range of complications, including infection, blockage, skin damage, thrombosis, catheter migration, and catheter rupture.

Infection is one of the most common complications of long-term catheterization. Dialysis catheter-related infections can be divided into: catheter outlet infections, catheter tunnel infections, and systemic infections.

How are dialysis catheter-related infections treated?

1. Exit infection

The skin around the catheter or on the surface of the tunnel is red, swollen, hot, and has purulent secretions. Generally, the infection occurs when the catheter is within 2 cm from the outlet.

2. Subcutaneous tunnel infection

The subcutaneous tunnel is swollen and purulent secretions can be seen at the exit. Infection in the subcutaneous tunnel of the catheter more than 2 cm from the outlet. At the catheter exit site, palpable erythema and/or induration >2cm along the catheter tunnel, with or without blood infection.

Treatment measures for the above two situations: Generally, there are no systemic symptoms such as fever, and local disinfection of the outlet, antibiotic ointment or oral antibiotics can be used.

3. Systemic infection

Typical manifestations of dialysis catheter-related infection include chills and fever during or after each hemodialysis session.

Treatment measures: At this time, it is necessary to collect the blood in the catheter for bacterial culture, and choose sensitive antibiotics for intravenous infusion, use through the catheter, or sealing the tube. If antibiotic treatment is ineffective or there is a fungal infection, the tube needs to be extubated.

How to deal with catheter thrombosis?

Thrombosis is the most common complication of dialysis catheter placement. Studies have shown that the incidence of thrombosis and embolism caused by long-term indwelling catheters is 9.24%. This is related to the patient's coagulation disorder and failure to replace the sealing solution in time for a long time.

Catheter autologous thrombosis – refers to thrombosis in the catheter or directly surrounding the catheter, which is divided into 3 types:

• Intraluminal thrombus – refers to thrombus that occurs within the catheter lumen

• Catheter tip thrombosis – refers to the thrombus that forms at the tip of the catheter

• Fibrin sheath thrombus – refers to a thrombus that directly surrounds the catheter as part of the fibrous sheath

The main reasons for the formation of thrombosis in the dialysis catheter include: the catheter is left in for too long; there is a hypercoagulable state; insufficient anticoagulant dosage; the catheter tube is twisted, etc.

Approach:

• Can be used: urokinase tube sealing, urokinase thrombolysis (once a day, 5 to 7 days);

• Or use anticoagulant therapy with warfarin or platelet inhibitors;

• Control hemoglobin levels (not too high hemoglobin);

• Avoid fatty meals (high-fat foods can easily lead to thrombosis);

• If repeated thrombolysis is ineffective, the catheter needs to be replaced.

What to do if the catheter is malfunctioning?

Catheter malfunction means that the blood flow in the catheter cannot continuously reach 200ml/min, and sufficient dialysis cannot be achieved.

If the blood flow is smooth in the early stage of dialysis, but during the dialysis process, the blood flow suddenly becomes insufficient, after ruling out the absence of thrombus, check whether the catheter is twisted. When catheter malfunction occurs, X-rays are also required to rule out catheter malposition, and the catheter needs to be replaced if necessary.

Catheter prolapse prevention and treatment

In order to reduce catheter prolapse, the catheter fixation wing should be fixed for at least one month, and a small number of malnourished kidney patients can extend the fixation time; once catheter outlet infection occurs, it needs to be treated as soon as possible.

Broken catheter

Long-term use of the catheter is long, and the catheter clip is prone to damage due to long-term use.

Treatment measures: For catheters with non-replaceable connectors, remove the catheter and reinsert it; for catheters with replaceable connectors, replace the arterial and venous end connectors.

Prevention: Change the position of the catheter clamp every time it is clamped; choose a catheter with replaceable connectors to extend the service life of the catheter.

Routine maintenance of dialysis catheters

(1). Wear a mask when getting on and off the machine, pay attention to personal hygiene, do not scratch the skin where the catheter is inserted, keep the local skin clean and dry, and avoid getting the catheter wet when bathing. You can put plastic wrap on the catheter location in advance, or choose a waterproof patch cloth.

(2). Pay attention to whether there is bleeding, redness and swelling at the exit of the catheter, and whether there is leakage from the entrance of the catheter tunnel. If there is bleeding, use local compression to stop the bleeding and seek medical attention immediately. If there is leakage, use a sterile cotton swab to clean it and seek medical attention immediately.

(3). Observe the catheter fixation to see if any sutures are loose. If so, notify medical staff immediately to avoid catheter slippage. If the catheter accidentally prolapses, apply pressure with your hands to stop the bleeding and seek medical attention immediately.

(4). Pay attention to the fixation of the catheter during activities to prevent twisting and slipping.

(5)After extubation, finger pressure should be performed for 30 minutes under the guidance of a doctor, and covered with sterile gauze. Local bleeding should be observed. Avoid showering on the day of extubation.

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