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Hemodialysis Shunts:

A surgically created arteriovenous connection used for hemodialysis.  A subcutaneous fistula may be accessed in critical patients requiring immediate medication administration in life-threatening situations only.


Establish Patency:

- Discontinue any current IV solution.

- Use caution when discontinuing a continuous IV infusion containing chemotherapy to minimize exposure.

- Use clean gloves.

- Prepare 10 mL syringe, IV administration set and IV solution.

- Prep injection port with alcohol swab.  If clamped, unclamp catheter.

- Slowly inject 5 mL NS into port.  If resistance is met, re-clamp catheter and do not use. (see dialysis catheter).

- Aspirate for blood. (For dialysis catheters only: Aspirate 3 - 5 mL blood and discard prior to injection of saline).

- If unable to get a blood return, re-clamp catheter and do not use. 

- If no resistance is met, inject remaining 5 ml NS into catheter.

- If resistance is met, re-clamp catheter and do not use.


Accessing Hemodialysis Fistula:

- Check site for bruits and thrills.

- Access fistula on the venous side (side with weaker thrill in patient with a pulse).

- Inflate BP cuff around IV bag to just above patient’s systolic BP to maintain flow of IV.

- If unsuccessful in accessing site, hold direct pressure over site for 10 minutes.


Administering IV fluids / medications:

- Prepare IV solution, IV administration set.

- Prep injection port with alcohol swab.

- Puncture injectable cap with appropriate device.  (Most home care injection caps are needle-less.)

- Tape needle to catheter.   Administer medications IVP via main line.

- Flush well with NS after each medication administered.



- Acute status patients.

- Cardiopulmonary arrest.

- For hemodialysis fistula - life-threatening condition requiring immediate vascular access.

- Medications - All medications approved for venous administration.


Types of Catheters:

External Silastic Indwelling Catheter/Devices:

- Broviac, Hickman and others: Silicone tube inserted in the chest; Heparinized and protected by injectable cap.


- Midline catheter: Enters the arm via vein near the AC area.  Commonly used for long-term antibiotic admin.


- PICC Line: Peripherally inserted central catheter inserted into right atrium via peripheral arm vein.


- Hemodialysis catheter: Large tube inserted into distal superior vena cava via the subclavian vein.  Usually a higher concentration of heparin is in the tube, which must be aspirated prior to use.

Internal Subcutaneous Infusion Ports: NOT approved for access by prehospital personnel.

A pre-existing vascular access device (PVAD): is an indwelling catheter/device placed into one of the central veins, to 

provide vascular access for patients requiring long term intravenous therapy or hemodialysis.



- Infection:  Use clean gloves.  Prep injection port.  Obtain new supplies if equipment becomes contaminated.

- Air Embolism: The PVAD provides a direct line into the circulation.  Introduction of air into these devices is hazardous.

- Do not remove injection cap from catheter.

- Do not allow IV fluids to run dry.

- Always expel air from preload/syringe prior to administration.

- Thrombosis: improper handling and maintenance of the PVAD can cause a blood clot within the vascular system.

- Dislodging a clot can cause a PE or vascular damage.  Follow medications with 10 mL normal saline.

- Do not inject medications or fluids if resistance is met when establishing patency.

- Catheter Damage:  Clamp immediately between skin exit site and damaged area to prevent air embolism or blood loss.

- Use patient’s clamp or padded hemostats if available or fold and tape tubing to clamp.

- Always use a minimum of a 10 mL syringe to prevent catheter damage from excess infusion pressure.

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