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Non-tunneled venous catheters provide access to cancer patients who develop acute kidney injury related to their treatment or diagnosis requiring urgent hemodialysis. Timely placement of catheters in the acute phase is crucial to optimal care delivery. A group of advanced practice providers (nurse practitioners) who perform hospital procedures at the bedside, which include central venous catheter placement allowed for prompt delivery of care of our cancer patients who needs emergent dialysis.
Retrospective review of the electronic medical records of the MD Anderson Cancer Center from September 2017-September 2023 was performed to identify all non tunneled vascular access procedures performed by APP`s for the vascular access service. Dialysis catheters were identified using indication for line placement (acute kidney injury, end stage renal disease, apheresis). Outcomes of interest were adequacy of dialysis blood flow, interruptions to therapy, clotting of access and catheter related blood stream infections within 30 days of line placement.
8306 non tunneled lines were placed by the APP`s from 2017-2023 of which 1197 were dialysis catheters used for hemodialysis or apheresis procedures.
Delivered dialysis blood flow rate was equal to the prescribed dialysis blood flow rate in 69% of catheters and duration of dialysis delivered was equal to duration of dialysis prescribed in 86% of catheters. Interruptions to dialysis from clotting of catheter was noted in 4.89% of treatments. Rates of CLABSI went down from 1.48 infections/1000 catheter days to 1.18 infections/1000 catheter days from 2017-2023
APPs provide a safe and efficient way of placing non-tunneled venous access for patients in need of hemodialysis access in high risk patients at a cancer hospital through adequate training with limited need for supervision. Risks and complications remain low with clinical safety and quality improvement initiatives to improve workflow processes and have positive outcomes.