Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Chan PS (1), Lee Maggie (1) (2) (3), Au WN (1), Tse YS (1), Lam CK (1), Pang YY (1), Yim CL (1), Lam WK (1), Cheung MK (2), Po LN (1), Tang YL (1), Mok Wendy (2), Chi CY (1), Yuen WH (3), Lee HK (1), Tong Matthew (2) (3), Yam P W (1), Yung C Y (2) (3)
Affiliation :
(1) Medicine & Geriatrics, Tuen Mun Hospital, (2) Medicine & Geriatrics, Tin Shui Wai Hospital, (3) Medicine & Geriatrics, Pok Oi Hospital
Introduction :
Haemodialysis catheter occlusion is one of the commonest technical problems of haemodialysis. It affects the dialysis adequacy and may lead to bloodstream infection. It is believed that the preservation of the catheter can be improved by a proper flushing technique. Thus, we carried out an evidence-based practice (EBP) project to explore the most effective CVCs flushing technique so as to improve the patency of the haemodialysis catheter for our patients.
Objectives :
To establish a best haemodialysis catheter flushing technique in NTWC renal units through an EBP project.
Methodology :
Johns Hopkins Evidence-Based Practice Model was adopted. The practice question was set as ‘What is the best flushing technique to maintain CVC patency for patients?’. An extensive search was conducted to collect all the related evidences. Total 534 articles were reviewed and 4 relevant, all are classified as level IIB, studies were selected. These studies were synthesized and showed that pulsatile flushing is the best CVC flushing technique in either reducing catheter occlusion or catheter bacterial colonization. A new practice of pulsatile flushing technique was then established as 10 successive boluses for each catheter lumen, 1 bolus contains 1 ml 0.9 % sodium chloride, 1 bolus should be injected in 1 second. A structural staff training including theory input and skill transfer on the new pulsatile flushing technique was provided to all the renal nurses. Following the staff training, a pilot implementation in all tunneled HD catheters was carried out in TMH T10 Renal Unit. The catheter occlusion rate was compared between the old flushing technique (10 ml 0.9% sodium chloride continuous flow to each catheter lumen) and the new pulsatile flushing technique.
Result & Outcome :
There were 117.6 episodes of catheter occlusion out of 1000 catheter days recorded in 24 catheters between 24/07/2023 and 20/08/2023 (pre pilot phase); 102.7 episodes of catheter occlusion out of 1000 catheter days found in 24 catheters between 21/08/23 and 17/09/23 (pilot phase). It showed a reduction in catheter occlusion rate. No adverse events were noted among the patients or staff. After the endorsement by the team heads, pulsatile flushing technique is further translated into all NTWC renal units as a new standard nursing practice to replace the old practice of continuous flushing technique. Positive feedback of the staff training was obtained from the involved nurses.
