Tunnelled central venous catheters in haemodialysis patients
Abstract:
Background: Tunnelled central venous catheters (T-CVC) are used globally as vascular access for patients on haemodialysis but are associated with increased sepsis, mortality, cost and length of hospitalisation when compared to more permanent haemodialysis vascular access. Reasons for use of T-CVC are varied and poorly understood. A significant and increasing proportion of incident haemodialysis patients in Victoria, Australia have required T-CVC over the last decade.
Methods: With rates of starting haemodialysis with definitive vascular access consistently below a Victorian quality indicator target of 70%, an online survey was developed to explore reasons why the rate remained lower than desired and to help inform future decisions about this quality indicator. The survey was completed by dialysis access coordinators over an 8-month period by vascular access coordinators and involved all public nephrology services in Victoria.
Results: Of 125 surveys completed, 101 incident haemodialysis patients had no attempt made at permanent vascular access prior to T-CVC insertion. For almost half of these (48 patients), there was no active medical decision not to create permanent vascular access prior to commencing dialysis. Reasons for insertion of T-CVC included deterioration of kidney function faster than anticipated, surgical referral overlooked, complications related to peritoneal dialysis requiring change in dialysis modality and changes to initial decisions regarding dialysis modality for kidney failure.
Conclusion: These survey results provide an opportunity for quality improvement initiatives with respect to dialysis access planning and care.
Reference:
Steinberg AG, Mount PF, Branagan M, Toussaint ND. Tunnelled central venous catheters for incident haemodialysis patients – a Victorian survey exploring reasons for use. Intern Med J. 2023 Mar 6. doi: 10.1111/imj.16051. Epub ahead of print. PMID: 36878856.