The secret life of dialysis catheters: A qualitative study of intensive care nurses’ experiences of managing dialysis catheters

INTRODUCTION: In Australian intensive care units (ICUs), approximately 9000 patients require renal replacement therapy annually for acute kidney injury. This requires a large-bore dialysis catheter to facilitate effective extracorporeal blood flow. However, these catheters have the highest failure rate of all central venous catheters used in ICU at 7-20%. While catheter insertion and renal replacement therapy guidance is evidence-based, there is limited guidance for post-insertion catheter care and troubleshooting. OBJECTIVE: To explore ICU nurses' experiences managing dialysis catheters, and how existing policies and bedside practices influence nurses' decision-making. METHODS: Qualitative, descriptive design. Registered nurses with experience caring for patients undergoing dialysis were recruited between November 2024 and January 2025. Data were collected through small group, semi-structured interviews and analysed using inductive content analysis. FINDINGS: Eighteen clinicians participated across three focus groups, with a mean of 10.6 years' experience in dialysis catheter care. Two themes were identified: (1) Troubleshooting is complex, characterised by reliance on experiential knowledge, time sensitive decision-making, and balancing risk against benefit; and (2) The hidden cost, reflecting the stress, unrecognised labour and financial burden associated with troubleshooting catheter dysfunction. CONCLUSION: The absence of evidence-based guidance to manage troubleshooting and catheter dysfunction places substantial burden on ICU nurses. Evidence-based troubleshooting decision tools may have the potential to improve dialysis efficiency, reduce healthcare-associated risks and workforce stress. IMPLICATIONS FOR CLINICAL PRACTICE: Effective post-insertion management of dialysis catheters requires clear, evidence-informed policy, particularly regarding safe, appropriate troubleshooting techniques. A structured hierarchy of interventions may enable efficient clinician response to catheter dysfunction and improve post-insertion care and reduce complications. Targeted education and skills training are essential to strengthen clinical judgement in time-critical situations. Improved interdisciplinary communication is also needed to ensure medical teams better understand the workload and clinical risks associated with managing dialysis catheters.