Introduction:
In the UK, 49% of patients commence haemodialysis (HD) using either a temporary or tunnelled central venous catheters. Both the UK Kidney Association and the Kidney Disease Outcomes Quality Initiative offer limited guidance on the insertion and removal of HD lines. Current practices across the UK are not standardized, with local guidelines available in only a minority of Trusts. We aimed to investigate the current practices of HD line insertion and removal across the UK, identify discrepancies in these practices and assess the need for national guidelines.
Methods:
A nationwide online questionnaire was distributed to access nurses, renal trainees, and consultants involved in dialysis line insertions and removals. A list of main renal units was obtained from the UK Kidney Association website, with a total of 72 units included.
The 27 question survey was divided into three sections, addressing various aspects of procedural practice including operator, assistance, location of insertion, personal protective equipment (PPE), and infection prevention protocols.
Results:
The survey has received 79 responses from 45 renal units. Tunnelled haemodialysis catheters are inserted by renal registrars and renal consultants in 84% and 80% of centres respectively. They are also the ones responsible for removal of tunnelled lines in most centres, followed by specialist access nurses in 38%. 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. Temporary dialysis line insertions are generally assisted by the ward health care assistants (HCAs) (58%) and ward nurses (38%). Ward nurse (38%) and specialist access nurses (27%) most commonly assist in the removal of tunnelled dialysis lines. The majority of temporary dialysis line insertions, along with the insertion and removal of tunnelled dialysis lines are carried out in a dedicated procedure room in or outside of the renal ward. Temporary dialysis lines are removed at the patient’s bedside in 84% of centres.
Among the renal centres, the median number of days which temporary femoral dialysis lines can remain in place is 7 (range 2 to more than 14). The median number of days which temporary internal jugular dialysis lines can remain in is 14 (range 5 to more than 14). 29 (65%) units did not have a specific cut-off for maximum CRP prior to the insertion of a tunnelled dialysis catheter. 12 (27%) units have a CRP cut off, which ranged between less than 20 to 100. The majority of centres do not use heparin during the first dialysis following a temporary (71%) or tunnelled line (55%) insertion. Most centres use a BiopatchTM or similar dressing over the exit sites of temporary (76%) and tunnelled lines (78%). Responses regarding trying the line following insertion and antimicrobial locking solutions are divided. 16 (36%) and 9 (20%) units do not routinely use any methicillin-sensitive Staphylococcus aureus (MSSA)/methicillin-resistant Staphylococcus aureus (MRSA) decolonisation following temporary and tunnelled line insertions respectively. In units which use decolonisation treatment, the most common treatments are mupirocin nasal ointment, octensian skin lotion and chlorhexidine wash.
Conclusions:
On-going data collection aims to include all renal units within the UK. Preliminary 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 standardised practice based on the best available evidence to enhance patient care.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.