B SMYTH1,2, S KOTWAL1,3, M GALLAGHER1,4, N GRAY5,6, K POLKINGHORNE7, on behalf of the REDUCCTION Trial Group
1The George Institute for Global Health, UNSW, Sydney, Australia, 2Sydney School of Public Health, University of Sydney, Sydney, Australia, 3Prince of Wales Hospital, Sydney, Australia, 4Concord Clinical School, University of Sydney, Sydney, Australia, 5Sunshine Coast University Hospital, Birtinya, Australia, 6Sunshine Coast Clinical School, University of Queensland, , Australia, 7Monash Medical Centre, Monash University, Melbourne, Australia
Aim: To describe dialysis catheter management practices in dialysis units in Australia and New Zealand.
Background: Dialysis catheter associated infections (CAI) are a serious and costly burden on patients and the healthcare system. Many approaches to minimising catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known.
Methods: Online survey comprising 51 questions, completed by representatives from dialysis units from both countries.
Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch (35%) and sterile dressing alone (31%) being most common. All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter associated bacteraemia per 1000 catheter days.
Conclusions: There is wide variation in current dialysis catheter management practice and evidence suggests that CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and the variation in practice suggests further work is required to better define the standard of care.
Dr Smyth is a nphrologist and PhD candidate at The eorge Institute for Global Health. His research interests include dialysis, especially randomised controlled trial methodology and evidence as well as patient reported outcomes in dialysis patients.