Seeing Eye to Eye: The Key to Reducing Catheter Use

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 VACs 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.