Dialysis Vascular Access Cases

Complex COVID-19 Patient Needs More Access | NCIA-10

Dialysis Vascular Access Cases: An intubated ICU patient required multiple critical care medications, including vasopressors. Additional complications included obesity and the development of cellulitis after the medical team failed to insert a left jugular. The patient experienced renal failure, and Vascular Wellness was consulted to place a temporary dialysis catheter. Upon assessment, the Vascular Wellness clinician concluded that in addition to a trialysis catheter, this patient also required additional central access that would preserve vasculature in case the patient required ongoing dialysis. Since the left jugular wasn’t an option and the right jugular was being used for dialysis, the Vascular Wellness clinician determined that the right internal jugular vein was large enough to double-stick safely. The clinician placed the lines in the same vein and independently dressed each, allowing four individual access points and the ability to remove the failing peripheral IVs.

Intubated Patient Needs Vascular Access After Failed Attempts | NCIA-11

Dialysis Vascular Access Cases: A COVID-19 patient with respiratory and renal failure received an emergent Temporary Dialysis Catheter but needed additional IV access. The patient’s peripheral IV failed, and the ICU nurses could not re-establish access. The physician attempted an internal jugular line but was unsuccessful. The patient continued to decline and required vasopressors, making the need for vascular access more urgent. Vascular Wellness was consulted to insert a PICC line; however, after assessing the patient, the clinician realized preservation of the upper arm veins was needed for future hemodialysis, and concluded a PICC was contraindicated. After an ultrasound assessment, the clinician consulted with the doctor to suggest a mid-thigh femoral, allowing for the safest delivery of therapies and preserving upper extremity vasculature. The Infection Control team and the physician were pleased, and the clinician arranged for the x-ray technologist to be at the bedside so rapid placement confirmation would allow critical care therapies to start immediately.