Hemodialysis Catheters - Frequently Asked Questions (FAQs)

The Centers for Disease Control Guidelines (CDC) for proper catheter site care recommend that either sterile gauze or sterile, transparent, semi-permeable dressing be used to cover the catheter site. Tunneled CVC sites that are well-healed might not require dressings. If the patient is diaphoretic, or if the site is bleeding or oozing, dressing the site with gauze is preferable is preferable to a transparent, semi-permeable dressing. If the catheter site dressing becomes damp, loosened, or visibly soiled it should be replaced. The CDC guidelines specify that topical antibiotic ointment or creams not be used on insertion sites (except when using dialysis catheters) because of their potential to promote fungal infections and antimicrobial resistance. Also, the CDC recommends that the catheter not be submerged under water. Click here to see the information included in the product IFU for catheter site care.

For more information on guidelines for vascular access, please reference KDOQI guideline #15 at http://www.kidney.org/professionals/kdoqi/guidelines and for more information regarding catheter site care visit the CDC website athttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

The CDC recommends changing the catheter dressing when it is damp, loosened, soiled, or when inspection of the site is necessary. For adult patients, dressings on short-term CVC sites should be replaced every two days for gauze dressings and at least every seven days for transparent dressings. Dressings used on tunneled or implanted CVC sites should not be replaced more than once per week, until the insertion site has healed. For more information on this information and similar guidelines, please visit the CDC’s website athttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

Every 48 hours, but no longer than 72 hours.

REFERENCE: Based on in vitro testing using 2:3 glycerine/deionized water solution with a viscosity of 3.2-3.5 cP at 37º C. Testing on file at Arrow International.

It is total volume per lumen including the extension lines. This information is printed on the catheter extension lines.

If the catheter is cut at some point other than the cut line, the priming volume will need to be adjusted. For every centimeter cut away from the trim line, the priming volume changes by 0.13 mL. To determine the new priming volume for each 1 cm the catheter is trimmed proximally (towards the catheter hub) from the trim line, the arterial and venous priming volumes should be increased by 0.13 cc. For each 1 cm the catheter is trimmed distally (away from the catheter hub) from the trim line, the arterial and venous priming volumes should be decreased by 0.13 cc.

To maintain patency of the catheter between treatments, a heparin lock is usually created in each lumen of the catheter. The concentration of heparin, or alternative anticoagulant, should be determined by hospital protocol or physician order. If the catheter will not be used, it is recommended that the catheter is flushed and re-locked, usually every 48 hours, but no longer than 72 hours. Prior to flushing the catheter using a positive-pressure flushing technique to help prevent occlusion, first aspirate out existing lock solution, then flush catheter with saline or as per facility protocol. Properly cleanse all connectors valves with an appropriate antiseptic before being accessed.

* Assess patient for heparin sensitivity. Heparin-induced Thrombocyopenia (HIT) has been reported with use of heparin flush solutions.

The concentration of heparin, or alternative anticoagulant, should be determined by hospital protocol or physician order.

No. The catheter and its components are not made with natural rubber latex.

Please see the product IFU for more information.

First make sure the MRI scanner meets the acceptable conditions. MRI procedures may be done immediately after a catheter placement. Please see the IFU for more information.

Yes. The catheter contains a Barium Sulfate filler, which makes it visible under fluoroscopy and on chest X-ray.

The Arrow® NextStep® Retrograde Catheter is indicated for use in attaining long-term vascular access for hemodialysis and apheresis. The NextStep® Retrograde is inserted percutaneously and is preferentially placed into the internal jugular (IJ) vein. It may be placed into the subclavian vein also. The Arrow® NextStep® Retrograde Catheter is intended for use in adult patients.

The Arrow® NextStep® Antegrade Catheter is indicated for use in attaining long-term vascular access for hemodialysis and apheresis. The Arrow® NextStep® Antegrade Catheter is inserted percutaneously and is preferentially placed into the internal jugular (IJ) vein. Alternately, this catheter may be inserted into the subclavian vein although the jugular vein is the preferred site. Catheters greater than 40 cm are intended for femoral vein insertion. The Arrow® NextStep® Antegrade Catheter is intended for use in adult patients.

The catheter can be used as soon as soon as proper tip location is verified and the inserting physician writes a prescription for catheter use.

No. The NextStep® Catheter is indicated for adult patients only.

Consult your payor organizations with regard to local coverage, bundling requirements, and reimbursement policies.

The green compression sleeve MUST be present when threading the compression cap onto hub connection assembly. Failure to do so may result in air embolism, blood loss, or catheter separation.

A 10 mL or larger syringe is recommended when infusing or flushing the catheter. Infusion pressures should never exceed 40 psi to prevent damage to blood vessels. A two-pound weight equivalent force on the barrel of a 3 mL syringe generates pressure in excess of 40 psi. The same two-pound weight equivalent force on the barrel of a 10 mL syringe generates less than 8 psi of pressure.

A chronic hemodialysis catheter is a long-term, tunneled, cuffed catheter that provides vascular access for dialysis treatments. It's most often used as a bridge to a permanent vascular access called an arteriovenous fistula (AVF) or arteriovenous graft (AVG). A chronic hemodialysis catheter also provides a vascular access for patients who cannot have a fistula or graft placed due to their medical condition.

Typically hemodialysis catheters are placed into a large vein in the neck. The NextStep® Catheter can also be placed into a vein in the upper chest or the groin. They are occasionally placed in the transhepatic and translumber regions if the physician determines such placement is warranted.

Here are a few recommendations for catheter care:

  • Keep surgical sites clean and dry until they are completely healed.
  • Keep exit sites clean and dry for at least 6-8 weeks.
  • If you experience any pain, redness, or swelling at the exit site of the catheter, immediately notify your doctor and dialysis nurse.
  • Do not pinch, poke, bend, or pull at your catheter.
  • Do not use sharp objects around your catheter.
  • Do not get your catheter wet until you have permission from your doctor.



When in doubt, ask your doctor or your dialysis nurse for advice.

If your catheter falls out or breaks, apply pressure to the site and immediately contact your physician and seek emergency medical attention.

Contact your physician for specific instruction.

Yes. The UVA rays may degrade the catheter’s material.

The KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines are evidence-based practice guidelines published by the National Kidney Foundation for all stages of chronic kidney disease. They were originally established in 1997 and have changed the practice of nephrology and improved outcomes and quality of life for kidney disease patients.

http://www.kidney.org/professionals/kdoqi/

Caution: U.S. Federal law limits this device to sale by or on order of a physician.
KDOQI is a trademark of the National Kidney Foundation, Inc. Teleflex, Arrow and NextStep are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. © 2013 Teleflex Incorporated. All rights reserved. 2012-0613