University of Wisconsin Hospital and Clinics
TITLE: Roles and Responsibilities for
Insertion and Removal of Central Venous
Catheters in the Hemodialysis Unit
REVISED: November 1, 2013
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Nurse Manager: Joan Watson, MS, RN
Director: Ann Malec, MS, RN
Medical Director: Alex Yevzlin, MD
To define roles and responsibilities of the Nephrology Fellow, Attending, and Registered Nurse
before during and after a Central Venous Catheter (CVC) insertion or removal procedure and to
provide guidance / best practice recommendations regarding patient care prior to, during and
immediately after insertion or removal of non-tunneled or removal of tunneled
A. Only Nephrology fellows are allowed to insert or remove temporary, non-tunneled
femoral, jugular or subclavian central venous catheter (CVC) in the HD unit.
B. Patients are to be evaluated by the nephrology fellow prior to scheduling the
procedure paying particular attention to the following:
1. Mental status, alert and oriented x 3, able to cooperate and follow instructions
2. General Care status patients may have lines inserted/removed in the HD Unit.
Intermediate Care (IMC) and Intensive Care (ICU) status patients are to have
lines inserted/removed in their respective units.
a. Refer to the Adult IV Administration Guideline to determine level of
care e.g.) antiarrythmics, pressors, blood pressure drips. Patients
requiring medication greater than a Level 2 may not receive treatment
in the HD unit.
3. Physical stamina, patients must have the ability to lie flat for the duration of
the procedure (approximately 30-60 minutes)
4. Patient’s hemodynamic parameters and lab values within acceptable limits
over past 24 hours, including coagulation studies
5. Patient’s pain tolerance, only local anesthetic is used in the HD unit. Patients
requiring moderate sedation for the procedure need to have alternative
arrangements, e.g.) Interventional Radiology, Cath Lab.
6. Patients requiring continuous CPAP or BiPAP may not receive these services
in the HD unit.
7. Overall condition of the patient
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C. Refer to UWHC Administrative Policy 8.18 Vascular Access Venous and Arterial
for guidance with site selection
III. GENERAL ASSESSMENT & MANAGEMENT INFORMATION
A. Nephrology fellow to explain the procedure in detail for the patient, complications,
benefits, risks, alternatives if any, and obtain the consent according to UWHC
Administrative Policy 4.17 Informed Consent.
B. Nephrology fellow to notify the HD unit and inform charge nurse of the plan to place
the line in the dialysis unit and relay all of the above mentioned information to the
C. Dialysis charge nurse will determine the appointment time for the procedure based on
the acuity of the patient, availability of staff and room and will contact the fellow
and/or the attending with the agreed upon time.
D. The dialysis nurse assigned to assist with the procedure is responsible for:
1. Preparing the CVC line insertion/removal tray according to UWHC
Hemodialysis Departmental Policy 6.1 Hemodialysis catheter line insertion
and removal tray set up
2. Continuous cardiac monitoring during the procedure.
3. Vital signs, i.e.) BP, Pulse, pulse oximetry and pain assessment a minimum of
every 15 minutes during the procedure.
4. Completion and submission of the UW Central Line Insertion checklist.
E. The attending physician covering the service will be responsible for observing the
fellow during the procedure and is expected to be in the room for the duration of the
procedure, assisting and/or consulting with Interventional Nephrology as needed.
F. Post procedure the Nephrology fellow is responsible for:
1. Disposal of sharp and blood contaminated disposable items. Trays and
surgical objects to be placed in the soiled utility room.
2. Placing the order for chest X-ray to verify correct placement, reading and
notifying the dialysis charge nurse of proper placement prior to initiation of
3. Checking with the dialysis nurse if the blood flow is adequate after placing the
patient on the HD machine.
A. Refer to UWHC Administrative Policy 13.26: Insertion and Maintenance of Central
Venous Catheters for Prevention of Central Line-Associated Bloodstream Infection
(CLABSI) and UWHC Departmental Policy 1.21 Nursing Patient Care Central Venous
Catheter, Adult and Pediatric for detailed information regarding CVC insertion and
A. The Nephrology Fellow will document the attestation and procedure note.
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B. The RN assisting with the procedure will document: Universal Protocol, vital signs, pain
assessment, applicable neurovascular assessments, insertion and/or removal of LDAs,
patient education and/or instructions.
A. UWHC Administrative Policy 8.18 Vascular Access Venous and Arterial
B. UWHC Administrative Policy 4.17 Informed Consent
C. UWHC Administrative Policy 13.26: Insertion and Mainten-ance of Central Venous
Catheters for Prevention of Central Line-Associated Bloodstream Infection (CLABSI)
D. UWHC Departmental Policy 1.21 Nursing Patient Care Central Venous Catheter, Adult and
E. UWHC Departmental Policy 1.28 Care of Hemodialysis/Apheresis Catheter
F. UWHC Adult IV Administration Guideline