Can normal medicine be administered through a Hemodialysis (HD) catheter?

Administration of Medications Through Hemodialysis Catheters

Medications should not be routinely administered through hemodialysis catheters due to increased risk of infection, catheter dysfunction, and potential negative impact on patient morbidity and mortality. 1

Risks of Medication Administration Through HD Catheters

• Hemodialysis catheters are associated with significant morbidity and mortality, primarily due to infection risk, and should be preserved exclusively for dialysis whenever possible 2
• Tunneled central venous catheters used for hemodialysis are already associated with excess morbidity and mortality compared to other vascular access types 3
• Catheter-related bloodstream infections (CRBSI) are a major complication of hemodialysis catheters, and additional manipulation increases this risk 4
• Each catheter access increases the risk of biofilm formation, which can lead to bacteremia and systemic infection 5

Exceptions for Medication Administration

Emergency Situations

• In life-threatening emergencies when no other access is available, the hemodialysis catheter may be used for medication administration as a last resort 1
• If the HD catheter must be used for medication administration, strict aseptic technique must be followed 1

Antibiotic Administration for Catheter-Related Infections

• Systemic antibiotics may be administered through the colonized catheter when treating catheter-related infections if antibiotic lock therapy cannot be used 1
• For hemodialysis CRBSI due to pathogens other than S. aureus, Pseudomonas species, or Candida species, empirical intravenous antibiotic therapy can be initiated through the catheter 1

Proper Medication Administration Techniques (If Absolutely Necessary)

• Use strict aseptic technique when accessing the catheter 1
• Thoroughly disinfect catheter hubs before accessing 1
• Administer medications during hemodialysis sessions when possible to minimize additional catheter manipulations 1
• After medication administration, flush with appropriate solution as per institutional protocol 1

Alternative Medication Administration Routes

• Peripheral venous access should be the primary route for medication administration in hemodialysis patients 1
• For patients with chronic kidney disease, the dorsum of the hand should be used for intravenous lines to preserve arm veins for future vascular access creation 1
• When peripheral access is difficult, consider other alternatives before using the HD catheter:
  • Small-bore peripheral catheters in sites other than potential future AV access sites 1
  • Midline catheters for short-term therapy when appropriate 1
  • Separate central venous catheter dedicated for medication administration if long-term therapy is needed 1

Special Considerations for Hemodialysis Patients

• Medication dosing for hemodialysis patients often requires adjustment based on renal function 6
• For patients on hemodialysis receiving antibiotics, dosing should be coordinated with dialysis sessions when possible 1
• Certain medications (like cefepime) have specific dosing recommendations for hemodialysis patients 6

Prevention of Catheter-Related Complications

• Use antibiotic lock solutions between dialysis sessions to prevent catheter-related infections 1
• Consider ethanol lock therapy (60%) along with systemic antibiotics for treating catheter infections 5
• Apply appropriate antimicrobial ointments to catheter exit sites based on culture results 1
• Monitor for signs of infection at every dialysis session 1

Catheter Care Best Practices

• Assess the vascular access and surrounding area by physical exam prior to every connection for potential complications 1
• Limit the use of temporary, noncuffed, nontunneled dialysis catheters to a maximum of 2 weeks due to increased risk of infection 1
• For patients requiring long-term hemodialysis access, tunneled cuffed catheters are preferred over noncuffed catheters 1