Guideline for Hemodialysis Catheter 1 Catheter dysfunction 1

Guideline for Hemodialysis Catheter 1. Catheter dysfunction (1) Dialyzer blood flow<200 cc/min (2) High VP, frequent alarm (3) Failure to aspirate 處理步驟 (1) forced aspiration with NS(10 cc 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 1 BT + NS 12 cc, 打入 3. 1 cc, 留置 1 h, 若無效可再重複1次 (6) 會診外科 or on Double lumen catheter

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

(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 > 72 h after tx remove cath * change antiobiotics(IV and lock soln) by culture report * B/C(+) 1 week after a complete couse tx Remove cath

* Interdialytic antibiotic lock therapy (a) Vancomycin( 5 mg/cc) 抽 1. 5 cc (b) Ceftazidime(10 mg/cc) 抽 1. 0 cc (c) Heparin (5000 u/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