Mapping national variation in hemodialysis central venous catheter management: A UK-wide survey

Abstract

Background/objective:

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 there are variations to clinical practice across the UK. 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 in practice.

Method:

An online questionnaire on the local protocol and practice surrounding temporary and tunneled HD line insertions and removals was used.

Result:

120 responses were obtained from all (71) the main renal units according to UKKA, over the nine-month data collection period. Duplicated responses from the same renal center were removed and responses from senior nephrologists prioritized. 42 (59%) of the centers analyzed stated to have an interventional nephrology service. In 70 (99%) and 55 (77%) of centers, 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 tunneled dialysis lines. The remainder of the lines are most frequently done by the interventional radiology team. Among the centers, the average maximum number of days which temporary femoral and internal jugular dialysis lines are protocoled to remain in place is 7 and 14 days respectively.

Conclusion:

This study provides the most comprehensive assessment to date of HD CVC management practices across the UK, revealing considerable variability in procedural protocols, infection prevention measures, line dwell times, and post-insertion care. The findings highlight a need for national, evidence-based guidelines. Sharing these results within the renal community may inform future consensus building and policy development.