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Current practice in dialysis central venous catheter management: Multi‐disciplinary renal team perspectives
Author(s) -
Craswell Alison,
Massey Debbie,
Wallis Marianne,
Sriram Deepa,
Gray Nicholas A,
Kotwal Sradha
Publication year - 2020
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13626
Subject(s) - medicine , dialysis , central venous catheter , intensive care medicine , kidney disease , catheter , best practice , patient safety , nursing , medical emergency , health care , surgery , management , economics , economic growth
ABSTRACT 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.