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Seeing eye to eye: the key to reducing catheter use
Maryum Chaudhry1, Cynthia Bhola, Mohammad Joarder
1University Health Network-Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
Insights
Patients often use central venous catheters (CVCs) for non-medical reasons or due to fear of disfigurement from other vascular access methods. Communication gaps exist between patients and vascular access coordinators regarding CVC use.
Area of Science:
- Nephrology
- Vascular Surgery
- Patient Care
Background:
- Central venous catheters (CVCs) are increasingly utilized for hemodialysis.
- A prevalence target of less than 10% for CVC use is recommended.
- Understanding persistent CVC use is crucial for optimizing vascular access strategies.
Purpose of the Study:
- To investigate the underlying reasons for patients' continued reliance on hemodialysis CVCs.
- To identify factors contributing to the persistent use of CVCs in hemodialysis patients.
Main Methods:
- A multicenter prospective observational study surveyed 322 hemodialysis patients and their vascular access coordinators (VACs).
- Patient and VAC responses regarding CVC use were compared using multirater kappa statistics.
- An 18-month follow-up survey of a subgroup of CVC users correlated with initial responses to explore predictive associations.
Main Results:
- The primary reasons cited by patients for CVC use were "non-medical" (34.8%), previous fistula/graft failure (25.8%), and fear of disfigurement (11.5%).
- Vascular access coordinators (VACs) agreed with patient reasons only 16.5% of the time, with partial agreement in 37.0% and disagreement in 46.5%.
- Twelve percent of patients desired CVC change, a sentiment unknown to their VACs 78% of the time.
Conclusions:
- "Non-medical" reasons and concerns about fistula/graft complications and aesthetics are key drivers of CVC use.
- Significant discordance between patient-reported and VAC-assessed reasons for CVC use highlights communication gaps.
- Improved predialysis education and realistic vascular access targets are essential to reduce CVC prevalence.
Purpose:
Hemodialysis central venous catheters (CVCs) are increasingly used, despite a prevalence target of <10%. The primary aim of our study was to understand why patients persistently use their CVCs.
Methods:
A multicenter prospective observational study surveyed 322 patients and their vascular access coordinators (VACs) to determine the reasons patients use CVCs. Their responses were compared using multirater kappa statistics. An 18-month follow-up survey was applied to a subgroup of patients consistently using their CVCs, and correlated with the VACs' and patients' previous responses. Predictive associations for specific reasons for CVC use were explored.
Results:
Patients indicated "non-medical" reasons (34.8%), having previously failed fistulas/grafts (25.8%), and fear of disfiguration (11.5%) as the main reasons for CVC use. The VAC was in agreement with the patient 16.5% of the time, in partial agreement 37.0%, and in disagreement 46.5%. Twelve percent of patients indicated a desire to change their CVC, yet the VAC was unaware of this 78% of the time.
Conclusions:
The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.
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