Authors (including presenting author) :
Tai CY, Chan JYH, Sung KMD, Ho KMC, Young IL
Affiliation :
Renal Unit, Department of Medicine, Queen Elizabeth Hospital
Introduction :
Flushing is an essential procedure to maintain haemodialysis (HD) catheter patency and prevent complications. A fast bolus flushing technique was adopted to maintain the patency of HD catheters in QEH Renal Unit. However, catheter occlusion remained a significant challenge that interrupts dialysis and increases related costs. Recent evidence showed that Pulsatile Flushing prevents clots and biofilm formation and reduces catheter occlusion by creating turbulence in flushing. This evidence base practice translated evidence to design a new Pulsatile Flushing protocol with standards to enhance the catheter patency and to improve clinical outcomes.
Objectives :
To evaluate the effectiveness of Pulsatile Flushing Technique in reducing the occlusion rate of HD catheter in QEH Renal Unit B5 after the implementation of new protocol on HD initiation and termination procedure.
Methodology :
Following the Johns Hopkins Evidence-Based Practice model, literature search revealed a new standard on flushing timing and volume, syringe size, and technique in flushing central venous catheters. It involves delivering 10 successive 1ml boluses of saline using 10ml syringe, with 0.4 second pause between each bolus. A protocol was developed on the implementation of this Pulsatile Flushing Technique on HD initiation and termination procedure. Demonstration video and high-fidelity simulator “PulsatileFlow ProSim” were designed with QEH MDSSC for staff training. Performance checklist was developed and applied to ensure the consistency of staff performance. Total 30 renal nurses completed the training and new practice commenced in December 2023. All QEH center-HD cases with tunneled catheters were included while non-tunneled temporary catheters were excluded. Catheter occlusion rate was monitored by counting the occlusion episodes that require urokinase administration or catheter removal.
Result & Outcome :
Data retrieved and compared one year before and after the practice changed from Dec 2022 to Dec 2024. Total 58 tunneled HD catheters involved. The catheter occlusion episodes significantly decreased from 46.8 to 12.4 per 100 patient-years (P<0.05). New occlusion episodes also markedly decreased from 41 to 4.1 per 100 patient-years (P<0.01). The finding supported that Pulsatile Flushing Technique effectively enhanced HD catheter patency, reduced catheter occlusions, lowered urokinase usage, and diminished catheter loss. This program translated the evidence into nursing practice and improved clinical outcomes on HD.
