Peritoneal dialysis catheter flushing in children: A national survey of practice patterns

BackgroundPeritoneal dialysis (PD) is widely used for the management of pediatric kidney failure due to quality-of-life advantages. However, practices for PD catheter flushing between placement and dialysis initiation are not well standardized and rely largely on expert opinion. This study aimed to characterize variation in flushing practices across U.S. pediatric centers.MethodsWe conducted a cross-sectional survey of Standardizing Care to Improve Outcomes in Pediatric End-Stage Kidney Disease (SCOPE)-affiliated pediatric PD programs. A 17-item questionnaire assessing institutional protocols and flushing practices was distributed in person to representatives from the centers attending the 2025 SCOPE Fall Meeting, with follow-up emails and the accompanying survey sent to nonattending and nonresponding centers. Responses were analyzed descriptively at the center level.ResultsForty-three of the 60 SCOPE-affiliated centers (72%) responded; 83% reported having a flushing protocol. Routine flushing was nearly universal (98%) across all pediatric age groups and was primarily performed by PD nurses. Initial flushing occurred either within postoperative days 0-1 or around 1 week after placement. Weekly flushing was most common, though frequency varied. Dianeal 1.5% (49%) and normal saline (39%) were the most common solutions, with a typical volume of 10 mL/kg. Heparin use varied: 34% used it routinely, 27% selectively, and 39% not at all, most often at 0.5 U/mL. Management of bloody effluent also differed across centers.ConclusionDespite near-universal PD catheter flushing in pediatric centers, practices vary considerably. These findings highlight the need for multicenter studies to inform evidence-based guidelines and standardize care.