Seeing eye to eye: the key to reducing catheter 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.