[QUOTE=Beth Witten MSW ACSW;11693]Have the doctors and nurses talked with your husband and you about the benefits of getting a fistula or a graft instead of using a catheter? Research has shown that catheters are prone to having clots both small and large, having higher infection rates, and making it more difficult to get adequate dialysis. Some people cannot get a graft or fistula, but any type of access can be used for any type of home dialysis. It may ease your mind about the clots and give your husband better dialysis if he had a fistula or graft.
So far as his catheter is concerned, what did the training nurse tell you about how to prepare the catheter before and after dialysis? I remember nurses flushing the catheter lumens with saline before dialysis and I believe they flushed with saline and and packed the lumens with saline and heparin after dialysis. I’m not sure if this is still the procedure, but hopefully one of the patients on this board can tell you what he/she does with the catheter
Here are a couple of sites with information about caring for vascular accesses:
– http://www.kidneyschool.org/pdfs/KS-Module_08.pdf
– http://www.kidney.org/atoz/atozItem.cfm?id=166[/QUOTE]
Hi there;
My partner has been doing Nightly home hemo dialysis for about 5 years. She has been using a cathater all this time… We have not seen any blood clots at the cathater… Using the Fresenius for about 4 1/2 years and only remember seeing clots in the venus chamber once or twice when I forgot to turn on the heperin pump and the dialyzer got clotted and had to remove her from the machine… But never any clots at the connectors at the cathater.
When you extract the heparin from the cathater do you see any clots in the syringe??? Squirt the blood from the syringe and see of you are getting a clot. there should be one everytime. If you are seeing clots I can’t see how they are getting past the dialyzer (filter). When we connect the patient I extract the heparin that is in the cathater lines and once a week flush the lines with saline before hooking up the patient. When I extract the heparin there is always a bit of clot in the syringe. (every treatment) the reason for the flush is to check if the cathater is working properly. If you feel any resistance in the syringe during the flush it is likely the cathater is not working properly and will have problems doing any treatment. Had that problem when we had to have the tips of the cathater replaced… They just loaded the cathater lines with TPA and it cleared un the clot in the lines. So the second time she had the tips replaced I had them load the lines with TPA and no problem with clotted line.
as for as the lines becoming disconnected… We have not had that problem also no infections or any problems. do not use anytype of leak detector. What we have found that works for us…
Before I attach the lines to the cathater:
I have the line connector wrapped with gauze soaked with betadine solution.
after 3+ minutes I attach a 3cc syringe and extract the heparin from the line. Keeping this betadine soaked gauze wrapped around the syringe & cathater connector until ready to hook patient to machine lines. do both red and blue lines that way.
then after I hook the lines up. I wrap a piece of tape around the connection and then wrap it with the betadine soaked gauze. (prevents infections)
I have a plastic box that I made that fits over the connections that is wrapped with the gauze. This keeps the gauze from drying out so when we get off after 7 hours the gauze is still wet with betadine.
As far as using heparine when we were in training for both machine Fresenius and NxStage while at the clinic we tried different bolus and loads until we were sure there was no clots in the dialyzer after the treatment. I have since leaving the training reduced my bolus and load/hour… as long as the dializer is clear of clots after the treatment. right now i bolus .8cc and set the heperin pump to .4cc/hour… for us after 7 hours the dializer is still clear except sometime there may be a streak in the dialyzer…
Hope this information helps
HemoHelper