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Updated: May 21, 2026
09:57
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Learning why patients with central venous catheters resist permanent access placement
1Billie Axley, MSN, RN, CNN, is Director, Quality Initiatives/RightStart, Fresenius Medical Care, Brentwood, TN, USA. billie.axley@fminc-na.com
Summary
Patients on hemodialysis often refuse permanent access due to negative past experiences or fear of pain. Addressing these concerns can help reduce central venous catheter (CVC) use and improve patient outcomes.
Area of Science:
- Nephrology
- Vascular Access
- Patient Education
Background:
- Central venous catheters (CVCs) pose significant risks, including higher morbidity and mortality in hemodialysis patients compared to other access types.
- Patient refusal of permanent vascular access contributes to the prevalence of CVC use.
Purpose of the Study:
- To identify patient-reported reasons for refusing permanent vascular access placement.
- To develop intervention strategies aimed at reducing CVC utilization.
Main Methods:
- A survey was distributed to Fresenius Medical Care North America outpatient dialysis facilities to collect patient reasons for resisting permanent access.
- Responses from 1573 patients were ranked by frequency.
- A workgroup of nephrology nurses and social workers analyzed results and reviewed literature.
Main Results:
- The top three reasons for refusal were: previous negative surgical experiences, prior non-functional permanent access, and fear/pain associated with cannulation.
- These findings highlight key barriers to permanent access adoption.
Conclusions:
- Understanding patient-specific barriers is crucial for developing targeted interventions.
- Healthcare teams can use this information to create strategies that improve patient education and support, ultimately reducing CVC reliance and enhancing patient outcomes.
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