Dialysis Vascular Access Cases
Vascaths and Permcaths for Dialysis Vascular Access Cases highlights some of the interesting Nurse Clinicians in Action cases that Vascular Wellness clinicians have encountered and participated in treatment. Our nurses place Dialysis Catheters, including Acute/Temp Vascaths and Tunneled Permcaths, at the bedside 7 days a week, after-hours, weekends, and holidays. This helps eliminate transportation costs, avoid dependence on other departments, reduce length of stay, decrease infections, and, of the utmost importance, enables dialysis to begin faster – typically the same day, any day of the week.
VascATH Cases
ANXIOUS PATIENT NEEDS HEMODIALYSIS | NCIA-42
Vascath for Dialysis Vascular Access Cases: An elderly patient who was newly diagnosed with end stage renal disease needed emergent dialysis to address an acute kidney injury superimposed on chronic kidney disease (additional injury to the kidney beyond the chronic kidney disease). The hospital contacted Vascular Wellness that evening and requested a Vascath, a large bore central line used for dialysis, to be placed the following day. The next morning, the vascular access clinician arrived, noted the patient was nervous and confused, and decided it was unsafe to proceed without first attending to the patient’s obvious stress. After the patient received some medication to help, the clinician returned with some co-workers to help keep the patient calm and safe during the procedure. The additional team members chatted with the patient and helped her stay comfortable and calm while the Vascath was inserted safely, quickly, and without difficulty. Hemodialysis began almost immediately after the insertion was complete and X-ray confirmation of correct placement was received.
CLOTTED FISTULA RESULTS IN URGENT VASCATH | NCIA-24
Vascath for Dialysis Vascular Access Cases: A patient who was recovering from major surgery in an LTACH was receiving hemodialysis when their fistula clotted off and treatment had to be halted. Because of the recent surgery, transportation to another facility’s Emergency Department and Interventional Radiology for a surgical procedure to place a Temporary Dialysis Catheter was contraindicated. The care team unsuccessfully tried other alternatives over the following days. Then they called Vascular Wellness and a nurse clinician trained in advanced procedures arrived at the patient’s bedside within three hours of the call. The vascular access expert reviewed the patient’s medical history and spoke with the patient and his wife about the procedure and their recovery goals. They were very nervous due to traumatic blood loss during a similar procedure by another provider, and the clinician assured them it should be minimal when done properly, that he had placed hundreds of advanced lines successfully, and that he’d be finished within an hour. Upon completion, the wife couldn’t believe her husband’s sheets didn’t need to be changed, and she asked the clinician if she could give him a hug.
Emergent Temporary Dialysis Catheter at the Bedside | NCIA-23
Vascath for Dialysis Vascular Access Cases: This case took place in a hospital that partnered with Vascular Wellness for standard and advanced vascular access services except for Temporary Dialysis Catheters, or Vascaths; in these cases the hospital transports patients to an affiliated hospital with a full Interventional Radiology department. While a Vascular Wellness clinician was inserting a PICC line at this facility for another patient, this patient began to decline and urgently needed a Vascath to initiate dialysis. Due to a bed shortage, the patient could not be transferred to the affiliated hospital. With the patient’s health rapidly deteriorating, the facility asked if they could quickly credential the Vascular Wellness clinician so the procedure could be performed immediately. Vascular Wellness immediately supplied the clinician’s competencies which were verified, and the clinician reviewed the patient’s medical history to verify there weren’t any contraindications, quickly assessed the patient’s vasculature utilizing ultrasound guidance, and placed a right internal jugular temporary dialysis catheter on the first attempt. Soon after, the patient began to receive the much-needed hemodialysis treatment.
PERMcATH Cases
VASCATH EXCHANGED TO TUNNELED PERMCATH | NCIA-43
Permcath for Dialysis Vascular Access Cases: A patient in an LTACH who had suffered many serious injuries in a motor vehicle accident needed emergent dialysis and Vascular Wellness was contacted for vascular access. A nurse clinician arrived promptly and placed a Vascath via a femoral approach due to a neck brace that could not be removed. Ten days later, the care team determined long-term dialysis would be needed, and Vascular Wellness was contacted again to place a Tunneled Permcath. The large bore trained nurse clinicians arrived and noted that the patient was still under strict orders to remain in a neck brace at all times, so the typical placement in the internal jugular vein was not possible. Upon assessment, the patient did not show any signs or symptoms of infection, and the current temporary dialysis site was clean and free from signs of infection (typical for Vascular Wellness placed lines). The clinicians determined a catheter exchange to the left femoral site was appropriate, and completed the exchange of the large bore Vascath to a large bore Tunneled Permcath at the patient’s bedside without issue. The patient continued to receive hemodialysis without any delay or interruption to her regular schedule.
TUNNELED CENTRAL LINE IN LTACH PATIENT | NCIA-38
Permcath for Dialysis Vascular Access Cases: An LTACH patient with chronic kidney disease and respiratory failure, as well as a complex medical history that included lower bilateral DVTs and a pacemaker, needed to have an existing Vascath replaced with a Tunneled Permcath for long-term hemodialysis. The Vascular Wellness clinician performed a detailed patient assessment, noting the temporary dialysis catheter in the right internal jugular had been placed two weeks prior by someone other than Vascular Wellness. The clinician closely examined the line to determine if a catheter exchange could be performed, and quickly determined that a catheter exchange was contraindicated. The dressing was soiled with dried blood around the site, the line was sutured in several places, and the device had been placed high up in the neck – all of which made the patient a poor candidate for a line exchange. The clinician carefully removed the old large bore line, cleaned the site, and removed the old sutures. She placed a Tunneled Permcath lower in the neck without difficulty, and within ten minutes of completion of the procedure, the X-ray had arrived and cleared the Tunneled Permcath for immediate use.
Permcath at Patient’s Bedside | NCIA-33
Permcath for Dialysis Vascular Access Cases: A patient in a hospital ICU needed abdominal surgery, but upon admission, needed urgent dialysis. Vascular Wellness placed a Vascath temporary dialysis catheter at the bedside so hemodialysis could begin immediately. After carefully monitoring the patient’s condition, the care team delayed the surgery and recommended a Permcath be placed so the patient could be discharged to receive six weeks of hemodialysis in order to improve the probability of the best patient outcome when he returned for the abdominal surgery. The Vascular Wellness vascular access expert arrived the same day of the order, and the entire procedure of inserting the Permcath was completed at the bedside within 45 minutes. Outpatient dialysis was able to be arranged immediately due to the speed in which the catheter was placed, and the patient was discharged on schedule. The dialysis technician was extremely pleased with the high flow rates achieved by the dialysis catheter, and the nephrologist was impressed with the speed and efficiency of the Vascular Wellness team.
Dialysis Vascular Access Cases: Key Points
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NURSE CLINICIANS IN ACTION case summaries involve challenging situations or intriguing clinical presentations where Vascular Wellness was able to create clinically appropriate access promptly, minimize sticks, and place the right line at the right time, the first time.
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Vascular Wellness provides comprehensive, quality, timely, and innovative vascular access services, including standard and advanced line placement, pediatrics, program management, education, training, and infection control and prevention to all healthcare settings such as Tertiary Hospitals, Community Hospitals, Long-Term Acute Care Hospitals, Hospital at Home Programs, Skilled Nursing Facilities, Surgical and Outpatient Centers, Hospice, and At-Home care. We support a 98+% Success Rate with 0% Insertion-Related Infection Rate across all lines, with an average response time of 3 hours. We help our clients improve patient outcomes, enable faster therapy, reduce costs, infections, and readmissions, decrease hospital length of stay, and reduce transportation expenses.
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