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OVERVIEW
Once a procedure will be performed it is important to conduct a focused (yet comprehensive) chart review so that one can prepare a history and physical note and also review any information that is relevant for the procedure. While placing a tunneled hemodialysis catheter may seem like a relatively basic procedure (in comparison to some of the other procedure that are conducted in the field of interventional radiology) a through chart review is still beneficial prior to conducting the procedure.
REVIEWING THE PATINT HISTORY
It is important to try and get a sense of the clinical context for the tunneled line placement by trying to understand the patient’s past medical history to the best of your ability (while focusing on the elements that inform our understanding of peri-procedural management). It is important to acknowledge that sometimes the information below may not be readily accessible however ideally these aspects of the patient’s history would be included in one’s chart review.
CIRCUMSTANCES REGARDING THE PATIENT REQUIRING DIALYSIS
The patient’s renal compromise is important to asses and understand (as this can directly inform peri-procedural management). Here are some important elements to try and evaluate:
- What caused the renal impairment in this patient? What are the underling disease processes that brought the patient to the point of needing dialysis (sepsis, diabetes, autoimmune disease, etc). Sometimes the causes are multifactorial.
- Is this patient new to dialysis or have they received dialysis before? Some patients will have end stage renal disease and already be familiar with dialysis while others may be complete new to the process (the information available in the chart will change depending on this context). If patients are currently receiving dialysis it is important to try and get a sense of their dialysis schedule as they may already be dialysis dependent.
- Does this patient have any other dialysis access? Has the patient had any prior AV grafts/fistulas? Do any of them still work? Do they have one maturing currently?
CO-MORBIDIEITES
Peri-procedural management will be informed directly by a patients co-morbidities (for example patients with diabetes will benefit from a finger stick prior the start of the case if they are coming outpatient to make sure their blood sugars are well controlled peri-procedurally).
In the case of patients needing a dialysis line here are some common co-morbidities that patients may have that also change your management of the patients
- Diabetes: can be very common cause of renal compromise in patients.
- Hypertension: very common in patients with renal disease and those volume overloaded who have not been able to get dialysis recently.
ALLERGIES
Always review patient allergies when performing your chart review. Make sure there are no allergies to medications that you will administer during the case (such as potentially IV contrast, although IV contrast is usually not given for a tunneled dialysis catheter placement).
REVIEWING THE PATIENTS MEDICATIONS
It is important to make sure you review patient medications prior to any procedure (as again this will inform per-procedure management). A patient’s medication list can also help elucidate some of their co-morbidities. It is also important to appreciate that how you evaluate these medications may change slightly based upon if the patient is presenting from the outpatient vs. the inpatient setting. Here are major categories of medications to evaluate for:
BLOOD THINNING MEDICATIONS/ANTI-COAGULANTS
Policies may change on what blood thinning/anticoagulant medications need to be held for a tunneled line however it is generally a good idea to make sure you know what the patient is taking
REVIEWING PATIENT VITALS
FOCUSED PHYSICAL EXAM
Given the constraints of practicing interventional radiology, your physical exam will likely be deferred until
REVIEWING THE PATIENTS LABS
REVIEWING RELEVANT PRIOR IMAGING
Page Updated: 03.31.2019