Improvement on Care of Haemodialysis Catheter for Patients Undergoing Haemodialysis in a Tertiary Hospital

Background

Haemodialysis catheter use has been shown to be associated with the highest risk of infectious events and mortality compared to other types of vascular access. The team aims to revise the current process of caring for the haemodialysis catheter in term of catheter exit site care and to prevent misuse of the catheter by healthcare workers to preserve the catheter as it is the ‘lifeline’ for the dialysis patients.

Result

The team evaluated 4 waterproof dressing in the markets. 3M Tegaderm I.V. Advanced Dressing (waterproof) was chosen based on staff and patients’ positive feedback after the trials. To prevent misuse of catheter, the team gathers feedback across all HD services in Singapore and the final solution was to have a ‘waterproof’ label to serve as a reminder to healthcare worker when they attempt to use the HD catheter for non-dialysis purpose. This project has received positive feedback from ground. There was higher staff satisfaction in handling of HD catheter. This is related to the possibility of manpower time saved for ‘wet dressing’. There was no reported of misuse of catheter for non-dialysis purpose since initiative started. Patient also reported better catheter and dialysis care based on post implementation survey on change of catheter’s dressing. In addition, the team also adopted an evidence based tool “MR VICTOR” (Singapore Version) to perform exit site assessment for HD catheter. The tool has been piloted in a renal ward and also renal dialysis center in a tertiary hospital.

Conclusion: Promoting ‘Zero Harm’ to patient is the common goal among the team members. The initiative has successfully promotes improvement in care of haemodialysis catheter for patients undergoing haemodialysis. Most importantly, evidence based practice was adopted to promote safe care.