N8 — Catheter Care and Infection Bundle

When: every catheter connection, disconnection, and dressing change.

Do this

1. Check first: exit site, tunnel, dressing, and the patient (fever, chills) at every session [6].
2. Masks for patient and staff; the patient turns the head away and limits talking.
3. Hand hygiene, gloves, and a clean field under the catheter limbs.
4. Clamp before opening. Confirm both limbs are clamped before any cap comes off.
5. Scrub the hub with chlorhexidine (povidone-iodine if intolerant) every time the catheter is accessed or disconnected [6].
6. Aspirate 2–5 mL of blood and lock from each lumen before connecting, one lumen at a time [6]. A taurolidine/heparin lock must always be aspirated and discarded [7].
7. Dressing change: alcohol-based chlorhexidine (more than 0.5%) on the skin; exit-site ointment per your unit protocol after checking catheter compatibility; change at least weekly and whenever wet or soiled [6].
8. Lock: saline flush, the prescribed lock at your protocol’s volume, clamp, and a new sterile cap every time.
9. Can’t reach the prescribed blood flow? That is catheter dysfunction: check position, clamps, and flush, then follow the thrombolytic protocol.

Call the nephrologist when

• Immediately: fever, rigors, hypotension, or confusion during or after dialysis. Draw two blood cultures (catheter hub and dialysis circuit) before the first antibiotic dose [6].
• Same day: pus or spreading redness at the exit site; tenderness or redness along the tunnel; the cuff is visible or the catheter looks longer.
• Before the next session: dysfunction not fixed by bedside maneuvers or one alteplase dwell.
• Monthly at rounds: the patient still has a catheter — ask what the permanent-access plan is.

Don’t

• Don’t leave a lumen open to air — clamp first, cap every time.
• Don’t infuse or flush the lock into the patient; aspirate it.
• Don’t use the catheter for blood draws or medications outside dialysis unless ordered.
• Don’t start antibiotics before cultures [6].
• Don’t use taurolidine/heparin in a patient with heparin-induced thrombocytopenia or pork allergy [7].