Incenter Hemodialysis Policies & Procedures

DaVita HealthCare Partners Inc.

Policy: 1-04-02

Printed copies are for reference only. Please refer to the electronic copy for the latest version.

TITLE:

CENTRAL VENOUS CATHETER (CVC) CARE

PURPOSE: To reduce the risk of infection in the patient and to reduce trauma to the catheter
and exit site while minimizing blood loss.
POLICY:
1. Only non-occlusive dressings, such as sterile gauze pads, will be used.
2. Dressings are changed every dialysis treatment on:
Non-cuffed catheters
Newly inserted cuffed catheters
Cuffed catheter exit sites that are not well healed
Exit sites with signs and symptoms of infection
3. Education of patients with catheters that require a dressing should include the following:
Sponge bath only
Keep exit site dressing clean and dry
Do not remove dressing or traumatize exit site or catheter
Observe for signs/symptoms of infection
Report any signs/symptoms of infection
4. Cuffed catheters with well-healed exit sites may not require a dressing but still require
examination and cleaning of exit site each treatment.
5. Education for patients with well healed exit sites may include the following:
May shower daily
Air dry exit site
Observe for signs/symptoms of infection
Report any signs/symptoms of infection
6. Exit site infection may be characterized by:
Erythema
Tenderness
Induration or purulence within 2 cm of the skin at the exit site of catheter
7. Tunnel infection may be characterized by:
Erythema
Tenderness
Property of DaVita HealthCare Partners Inc.
Origination Date: September 2007
Revision Date: April 2009, March 2014, September 2014
Page 1 of 2

Confidential and Copyrighted 2007-2014

Policy: 1-04-02

Incenter Hemodialysis Policies & Procedures

DaVita HealthCare Partners Inc.

Policy: 1-04-02

Induration in the tissues overlying the catheter and > 2 cm from the exit site

8. Catheter related blood stream infection may be characterized by:

Isolation of the same organism (i.e., identical species) from a culture of a catheter
segment and from the blood of a patient with accompanying clinical symptoms
and no other apparent source of infection
In the absence of laboratory confirmation, indirect evidence of a blood stream
infection may be considered if signs and symptoms of infection diminish after
removal of an implicated catheter
9. Catheters may be made of various materials. Some materials cannot be exposed to certain
germicidal agents or ointments. For example, povidone iodine solution can produce
adverse effects on silicone catheters over time.
10. Acceptable germicidal/disinfectant solutions may include:
Isopropyl 70% alcohol
Povidone iodine (not approved for TEGOs)
Hypochlorite (ExSept Plus) only for skin including exit site cleaning
Chlorhexidine Gluconate 2%/Isopropyl Alcohol 70% (Chloraprep) only for
skin including exit site cleaning
Alcavis 50 only for central venous catheter (CVC) caps including TEGO
silicone, needleless connector caps, limbs and line connections
11. An access history will be maintained in each patients medical record. This may include:
Diagram of the current access with direction of flow
Surgeon involved with placement or intervention
Date of access placement
Type and location of access
History of infection, clotting and other interventions or revision procedures on
the access
12. CVC lumen and blood tubing connections will be verified for accurate, patent and secure
connections, and remain visible throughout the treatment.
13. Document findings and interventions in patients medical record.

Property of DaVita HealthCare Partners Inc.

Origination Date: September 2007
Revision Date: April 2009, March 2014, September 2014
Page 2 of 2

Confidential and Copyrighted 2007-2014

Policy: 1-04-02