PURPOSE: To clean and assess catheter, check for patency, before drawing blood. After blood is drawn, make sure catheter is flushed properly, and heparin placed.

SUPPORTIVE DATA:

Strict adherence to catheter care is necessary to prevent infection of exit site, which could lead to sepsis and heparin placement, to prevent clotting.

EQUIPMENT:

1. 2 packages 4 x 4
2. Povidone iodine solution
3. Towel
4. 1 5 ml syringe for each port used
5. 1 10 ml syringe with normal saline (for each port used)
6. Syringes for the amount of blood to be drawn
7. 1 3 ml syringe filled with heparin (1000 USP Units/ml)
8. Luer lock cap for each port used

NURSING ACTION:  Obtain MD order before drawing blood from Dialysis Catheter unless it has the "Pigtail Port".

PROCEDURE STEPS:

1. Carefully open two 4x4 packages. Apply Povidone iodine solution to 1 pkg of 4X4. Prepare 10 ml syringe with normal saline.
2. Place towel under exposed catheter lumens. Pick up 4x4 with Povidone iodine by corners; scrub arterial port for one minute. Securely wrap same 4x4 around port. Povidone iodine soaked 4x4 should remain on ports 3-5 minutes.

3. Remove 4x4s from port, remove caps, and place sterile 4x4 under catheter ports. Connect 10ml syringe to arterial port and aspirate 5ml. Close clamp, replace syringe with lab syringe, open clamp and aspirate the desired amount of lab drawn. Close clamp.

4. Connect 10ml syringe of normal saline to arterial port. Open clamp. Flush line with 10ml normal saline. Clamp.
5. Connect 3ml syringe to arterial port. Open clamp. Flush with 2ml of 1:1000 Heparin. Clamp.

6. Apply Leur Lock caps.

REFERENCES: Anna Core Curriculum

RESOURCE PERSON(S): Cathy Brothers, RN; Betty Casali, RN