Dr Benjamin Lazarus1,2,9, Dr Sradha Kotwal1,3, Prof Martin Gallagher1,4, A/Prof Nicholas Gray5,6, Ms Sarah Coggan1, Dr Kris Rogers1, A/Prof Girish Talaulikar7,8, Prof Kevan Polkinghorne2,9
1The George Institute for Global Health, Newtown, Australia, 2Monash University, Clayton, Australia, 3Prince of Wales Hospital, UNSW, Sydney, Australia, 4South Western Sydney Campus, UNSW, Sydney, Australia, 5Sunshine Coast University Hospital, Birtinya, Australia, 6University of the Sunshine Coast, Sippy Downs, Australia, 7The Canberra Hospital, Garran, Australia, 8Australian National University, Acton, Australia, 9Monash Health, Clayton, Australia
Aim: To determine whether kidney services can reduce the incidence of haemodialysis central venous catheter (CVC) dysfunction through multifaceted interventions
Background: Haemodialysis catheter dysfunction is common, costly, and generates additional procedures and hospitalization. Whether multifaceted interventions can prevent catheter dysfunction is unknown.
Methods: Post-hoc analysis of REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION), a stepped-wedge cluster randomized trial conducted in 37 kidney services in Australia. The broad multifaceted intervention included promotion of ultrasound guided CVC insertion in the right internal jugular vein. Catheters removed for poor flow, as assessed by the treating clinician, were considered dysfunctional. Mixed-effects Poisson regression was used to compare the service-wide incidence of catheter dysfunction during the intervention and baseline periods. Among tunnelled catheters, the role of CVC insertion site was examined, and the proportion of variance in catheter dysfunction incidence attributable to unmeasured participant and catheter factors was calculated.
Results: In total, 855 events of catheter dysfunction were identified over 1.07 million catheter days, an incidence of 0.80 events per 1000 catheter days. The intervention was associated with a 31% reduction in the service-wide incidence of catheter dysfunction after adjustment for calendar time and clustering within services (IRR 0.69, 95% CI 0.51-0.92). The association persisted among tunnelled catheters after adjustment for catheter site, tip design, and participant characteristics (IRR 0.69, 95% CI 0.50-0.95). At one year, unmeasured participant factors accounted for 41.6% of the total variance in catheter dysfunction incidence, whereas service factors accounted for 3.4%.
Conclusion: Implementation of multifaceted interventions targeting best catheter care practice was associated with a lower burden of catheter dysfunction. The mechanism by which this observed reduction occurred requires further study.
Biography:
Ben is an early career nephrologist at Monash Health and a full time PhD candidate at Monash University and The George Institute of Global Health. His thesis examines the risks of using central venous catheters for haemodialysis in Australia, and the opportunities we all have to make these devices safer for patients.