Table 3.

Algorithm for malfunctioning central venous catheter

Criteria
  • Inability to maintain sustained pump speed >200 ml/min for one hemodialysis run.

  • Difficulty aspiring from either lumen of the catheter.

    • Check for kinks beneath catheter clamps.

    • Change patient position.

    • Flush vigorously.

    • Reverse lumens.

tPA Procedure
  • tPA instillation for 30 min predialysis (or instill tPA at the end of dialysis in preparation for the next dialysis session).

  • Aspirate lumen(s) and attempt dialysis; if flow is established, proceed with dialysis.

  • If flow is not established:

    • Infuse 4 mg tPA over 1 h.

    • Reverse lines connecting venous blood line to arterial port.

    • Run infusion via pump into venous drip chamber.

    • If both limbs of the catheter have sluggish flows, the lines may be reversed after 30 minutes.

  • If flow is still not established, refer to Radiology for management of fibrin sheath, if present.