#575 Mapping national variation in haemodialysis central venous catheter management: a UK-wide survey

Abstract Background and Aims Both the UK Kidney Association (UKKA) and Kidney Disease Outcomes Quality Initiative (KDOQI) have limited guidance on the insertion and removal of HD central venous catheter (CVC) lines. Anecdotally the practice across the UK is not consistent with variations in clinical practice. While some Trusts maintain local guidelines, standardized national protocols are lacking. We aimed to evaluate current practices related to HD CVC insertion and removal within UK renal units to identify variations and highlight potential best practices. Method An online questionnaire on the local protocol and practice surrounding temporary and tunnelled HD line insertions and removals was used. Information surveyed included individual renal centre's procedural protocols such as operator, assistant, location, personal protective equipment (PPE) and infection prevention practices. The online survey was finalized in December 2023 and disseminated nationally. A list of the 72 main rental units were obtained from the UK Kidney Association (UKKA). The number of responses per centre was not limited. Results 120 responses were obtained over the nine-month data collection period. 4 responses were excluded as they were from centres not considered as a ‘main renal unit’ by UKKA. Two units have since merged, and hence data from 71 renal units were utilized. Duplicated responses from the same renal centre were removed and responses from senior nephrologists prioritized. 42 (59%) of the centres analysed stated to have an interventional nephrology service. In 70 (99%) and 55 (77%) of centres, renal registrar and consultants insert temporary dialysis lines respectively. Temporary dialysis lines are most often removed by the ward nurses (69%) and the dialysis nurse (42%). Renal staff commonly insert both inpatient and outpatient right internal jugular and femoral tunnelled dialysis lines. The remainder of the lines are most frequently done by the interventional radiology team. Among the centres, the median number of days which temporary femoral dialysis lines should remain in place is 7, and14 days for temporary internal jugular dialysis lines. The majority of centres do not use heparin during the first dialysis following a temporary (59%) or tunnelled line (61%) insertion. Most centres use a BiopatchTM or similar dressing over the exit sites of temporary (62%) and tunnelled lines (72%). 21 (30%) and 10 (14%) units do not routinely use any MSSA/ MRSA decolonization following temporary and tunnelled line insertions respectively. In units which use decolonization treatment, the most common treatments are mupirocin nasal ointment, octensian skin lotion and chlorhexidine wash. Conclusion Our results indicate substantial variability in the practices of inserting and removing of both temporary and tunnelled haemodialysis lines nationally. These findings underscore the need for nationally standardized, evidence-based guidelines to improve patient safety, reduce complications, and enhance overall care quality. Sharing these results within the renal community may inform future consensus building and policy development.