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Home | Articles | Renal | Care of Vascular Access

Care of Vascular Access

Last updated 3rd December 2020

Last updated on 7th August 2013 by Calum Murray

Introduction

  1. Good haemodialysis requires good vascular access
  2. The veins of a patient with CKD who might require dialysis should be preserved at all costs
  3. Similarly, the fistula or goretex graft in a patient who already has vascular access must be cared for meticulously
  4. Around 20% of dialysis patients will have either a temporary or tunnelled double lumen central venous catheter
  5. Most central venous catheters are placed in the right internal jugular vein. Alternative sites are left internal jugular (slightly more difficult to place), subclavian (risk of stenosis) and femoral veins (greater risk of infection).

Venesection

  1. If a haemo patient needs non urgent blood sample ask the renal nurses to do this at the next dialysis
  2. If you have to take blood yourself, use a butterfly rather than 21g needle, try the back of the hand first, then the antecubital fossa, avoiding the forearm veins as these are reserved for vascular access
  3. Renal patients are anaemic so avoid taking more blood than necessary – 5ml only for U&E, Ca, PO4, CRP & 3ml for FBC

Venflons

  1. The safest veins for venflons are on the back of the hand
  2. Avoid antecubital fossa if you can, and particularly the forearm veins as these sites are reserved for vascular access
  3. Cannulate for specific use and remove as soon as possible.

Care of Vascular Access

  1. Never take blood from a fistula or goretex graft
  2. Do not use triple lumen internal jugular, subclavian or femoral lines for venesection or IV fluids unless agreed with renal unit, in which case they will do it for you.
  3. If, in an emergency, you have to use a line then do so but let Renal Unit know.

Aseptic Technique for Accessing Lines

  • Wear sterile gloves
  • Use dressing pack
  • Clinell wipes (70% alcohol 2% chlorhexidine gluconate) to clean hubs
  • Remove lock – 5ml
  • Flush with 10ml saline after use
  • Lock with Taurohep solution (mixture of taurolidine and heparin) to volume shown on side of catheter