Seeing eye to eye: the key to reducing catheter use

J Vasc Access. Apr-Jun 2011;12(2):120-6. doi: 10.5301/jva.2011.6390.

Abstract

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Catheterization, Central Venous / statistics & numerical data*
  • Catheters, Indwelling / statistics & numerical data*
  • Data Collection
  • Female
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Dialysis / statistics & numerical data*
  • Young Adult