Postinsertion care practices for nontunnelled dialysis catheters in intensive care: A cross-sectional survey

BACKGROUND: Dialysis catheters facilitate renal replacement therapy in critically ill patients with acute renal failure. However, they have the highest failure rate of all central venous access devices, estimated at 7-20%. Their unique postinsertion management requirements to maintain extracorporeal blood flow may contribute to increased rates of complications and failure. OBJECTIVES: The aim of this study was to describe current clinical practices of Australian critical care nurses caring for nontunnelled dialysis catheters in intensive care units to identify opportunities for practice improvement. METHODS: A cross-sectional, internet-based survey explored six postinsertion clinical practice domains. Critical care nurses with experience of caring for dialysis catheters within the last 12 months were eligible to participate. RESULTS: From 276 responses, 205 (74%) met minimum data requirements and were included in the analysis. Most respondents were registered nurses (97/205, 47%), clinical nurses (41/205, 20%), or clinical nurse specialists/consultants (48/205, 23%), with more than 15 years' experience (82/203, 40%), working in adult settings (156/205, 76%). For 85% (172/203) of respondents, a policy guiding postinsertion care existed in their unit. Most commonly, insertion sites were inspected once a shift (76/198, 38%); covered with bordered chlorhexidine gluconate-impregnated dressings (111/193, 58%); which were changed every 7 days and as required (109/192, 56.8%). Catheters were commonly secured with insertion site sutures (176/196, 90%). Ninety-seven unique dressing and securement combinations were reported. Heparin was the most used medication for catheter locking (124/190, 65%). To troubleshoot catheter dysfunction, respondents repositioned patients (177/182, 97%), swapped access/return lines (170/182, 93%), applied traction (154/182, 85%), flushed (145/182, 80%) and/or rotated catheters 180° (112/182, 62%). CONCLUSIONS: This survey demonstrates some variability in postinsertion care practices for dialysis catheters in Australian intensive care units, likely driven by the lack of specific evidence in this area. Findings suggest opportunities may exist where practice variability was observed, and these findings can help guide priorities for future interventional research.