Hi! This is Joe Atkins and I'm a certified nephrology nurse (20+ years) with 38 years of dialysis experience.
Only RNs can access or dress central venous lines at our center. We have LPNs, but, at this point, they do not access them. Not because they aren't capable; it's just a union hang-up.
We use large and small op-sites, depending on the size of the patient, along with a biopatch. Dressings are changed weekly and chlorhexidine is used to clean the sites, unless the patient is allergic, then old school betadine is used.
Heparin dwells used to be 5000u/ml when I first came, but we did a best practice literature search and discovered that 1000 u/ml would work just as well. It has for the last five years, with no increase in catheter thrombosis.
Activase is used as a dwell for patients with heparin induced thrombocytopenia. 1 mg per site.
For patients with recurrent infections, 2.5 mg of gentamicin mixed with heparin is used for each site as a maintenance dwell.
Although we try, it's difficult to work with the interventional radiologist, because they are contracted out of Columbus. They still tend to position the arterial limb of the catheter laterally, rather than, medially, which sometimes causes us to have to run the catheter in reverse, which we all hate.
Any tricks or magic bullets you folks have would be deeply appreciated.
Thanks,
Joe