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Guideline for Hemodialysis Catheter

Guideline for Hemodialysis Catheter. Catheter dysfunction (1) Dialyzer blood flow<200cc/min (2) High VP, frequent alarm (3) Failure to aspirate 處理步驟 (1) forced aspiration with NS(10cc syringe) (2) 改變病人姿勢 (3) A & V 端管路互換 (4) catheter 位置調整

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Guideline for Hemodialysis Catheter

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  1. Guideline for Hemodialysis Catheter • Catheter dysfunction (1) Dialyzer blood flow<200cc/min (2) High VP, frequent alarm (3) Failure to aspirate 處理步驟 (1) forced aspiration with NS(10cc syringe) (2) 改變病人姿勢 (3) A & V 端管路互換 (4) catheter位置調整 (5) intraluminal thombolytic therapy urokinase 1BT + NS 12cc,打入 3.1cc,留置1h,若無效可再重複1次 (6) 會診外科 or on Double lumen catheter

  2. Guideline for Hemodialysis Catheter 2. Catheter infection • Exit site infection (exit site附近2cm內有紅腫熱痛 or pus )  pus culture mupirocin oint + augmentin 1# qd for 2 weeks • Tunnel infection (exit site附近2cm內有紅腫熱痛 +- exit site附近有pus )  pus culture IV antibiotic( vancomycin+ ceftazidime for 2-4 weeks)

  3. (3) Catheter-related bacteremia ( B/C(+), fever,排除其他infection source) Severe symptoms ( septic shock, resp failure…) remove cath + IV antibiotic for 2-4 wks * Minor symptoms IV antibiotic + interdialytic antibiotics lock for 2-4 wks * if fever > 72h after tx remove cath * change antiobiotics(IV and lock soln) by culture report * B/C(+) 1 week after a complete couse tx  Remove cath

  4. * Interdialytic antibiotic lock therapy (a) Vancomycin( 5mg/cc) 抽 1.5 cc (b) Ceftazidime(10mg/cc) 抽 1.0 cc (c) Heparin (5000u/cc) 抽 1.0 cc * HD結束後,把lock soln打入cath,下次HD前,先把lock soln抽出

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