Dialysis catheter management practices in Australia and New Zealand

Smyth, Brendan; Kotwal, Sradha; Gallagher, Martin; Gray, Nicholas; Polkinghorne, Kevan R.

doi:10.1111/nep.13507

Cited by 12 publications

(18 citation statements)

References 22 publications

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“…(6) Many interventions have been studied with the aim of reducing HD-CRBSI, and the nature of this literature has likely contributed to practice variation. (6)(7)(8)(9) The recent Making Dialysis Safer for Patients Coalition initiative, led by the Centers for Disease Control and Prevention (CDC), is testament to the need for standardized approaches to infection prevention in dialysis services as was the success of the Keystone Michigan Project. (10,11) Herein, we review the research that formed the basis of the design and protocol of the REDUcing the burden of dialysis Catheter ComplicaTIOns -a National approach (REDUCCTION) trial, a stepped-wedge cluster randomized clinical trial of a suite of clinical interventions aimed at reducing the rate of HD-CRBSI across Australian renal services.…”

Section: Introductionmentioning

confidence: 99%

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) – design and baseline results

et al. 2020

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BackgroundPatients with hemodialysis central venous catheters (HD CVCs) are susceptible to health care-associated infections, particularly hemodialysis catheter-related bloodstream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.MethodsThe REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of design (mid-2018).ResultsA total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure.ConclusionsThe REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs.

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Section: Introductionmentioning

confidence: 99%

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) – design and baseline results

et al. 2020

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“…This study is important because it identifies that, despite the availability of a range of evidence‐based clinical practice guidelines in relation to insertion, management and removal of dialysis CVC's, considerable variation in clinicians' practice was evident. While this has been identified in other studies, this is the first study to seek clinicians' perceptions about their practices and thus makes an important contribution to knowledge and understanding of challenges clinicians face.…”

Section: Discussionmentioning

confidence: 96%

“…The findings align with other studies that identified inconsistency in dressing practices. 7,22 It is uncertain why these variations in practice exist but it appears to relate to perceived environmental and patient factors rather than evidence. This lack of standardization with attendant variation in practice may be regarded as unsafe.…”

Section: Discussionmentioning

confidence: 99%

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Current practice in dialysis central venous catheter management: Multi‐disciplinary renal team perspectives

Craswell

Massey

Wallis³

et al. 2019

Nephrology

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Aim To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. Methods This qualitative descriptive study involved semi‐structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty‐eight face‐to‐face interviews were conducted. A modified five‐step qualitative content analysis approach was used to analyse the data. Results Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access‐related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. Conclusion The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research‐based decision‐making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.

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“…The results relating to catheter management have been previously reported. 8 Here, we present the results describing current variation in arteriovenous access management practices in both countries.…”

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confidence: 99%

Arteriovenous access practices in Australian and New Zealand dialysis units

et al. 2019

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Background: The creation and maintenance of dialysis vascular access is associated with significant morbidity. Structured management pathways can reduce this morbidity, yet practice patterns in Australia and New Zealand are not known. We aimed to describe the arteriovenous access practices in dialysis units in Australia and New Zealand. Methods: An online survey comprising 51 questions was completed by representatives from dialysis units from both countries. In addition to descriptive analysis, responses were compared between units inside and outside of major cities. Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 38% of dialysis units in Australia and New Zealand. While 94% of units provided pre-dialysis education, only 60% reported a structured pre-dialysis pathway and 69% had a dedicated vascular access nurse. Most units routinely monitored fistula/graft function using flow rate measurement (73%) or recirculation studies (63%). A minority used routine ultrasound (35%). Thrombectomy, fistuloplasty and peritoneal dialysis catheter insertion were rarely performed by nephrologists (4%, 4% and 17% of units, respectively). Units outside of a major city were less likely to have access to a local vascular access surgeon (6/13 (46%) vs 35/35 (100%), P < 0.001). There were no other significant differences between units on the basis of location. Conclusion: Much variation exists in unit management of arteriovenous access. Structured pre-dialysis pathways and dedicated vascular access nurses may be underutilised in Australia and New Zealand. The use of regular access blood flow measurement and ultrasound is common in both countries despite a lack of data supporting its effectiveness. There is room for both practice improvement and a need for further evidence to ensure optimal arteriovenous access care.

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Dialysis catheter management practices in Australia and New Zealand

Cited by 12 publications

References 22 publications

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) – design and baseline results

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) – design and baseline results

Current practice in dialysis central venous catheter management: Multi‐disciplinary renal team perspectives

Arteriovenous access practices in Australian and New Zealand dialysis units

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