Increasing number of dialysis catheters

[scootersuz, ASN]

I have worked in our dialysis clinic for over four years. We run 24 patients each shift. Two nurses with 12 patients each. We have had an increasing number of vascular accesses clot off and now we have almost all catheters. On each shift there are usually 9 to 10 catheters out of the 12 patients.  That's means I have to assess, hook up and start 9 or 10 Patients myself since techs can't do that in California.  We have the same techs, same vascular surgeons etc. no change in technique. 
The other clinic in town has the same issue. Anyone else seeing this trend with increased clotting of AVF's? More clotting issues? 

Additionally, we have had so many patients pass in the past six months. We went from a patient population of about 120 to 70. They didn't pass from Covid. Mostly a mix of cardiac arrest, stroke or unknown cause and found at home. It's been sad.  We have had more pts receive transplants than usual also.  That's always great news. 

 

Had to drop one shift and went from three to two.  Now instead of being understaffed, we are over staffed with nurses on mandatory pto until we either get more patients or lay off some nurses.  We went from having three nurses at turnaround time to  having just one nurse on each side of the clinic with 12 patients,  almost all of them with catheters. We also still do blood transfusions here. I rush all day long just to get them their meds, antibiotics, Tpn and help with all the other typical dialysis issues that come up. Our clinic unique in its design. It is long and stretched out.

Would love to hear if other nurses seeing this increase ?

[Duncan6]

That's a lot of catheters!  The only thing I can think of is if there was maybe a change in heparinization.  Using less heparin, change in the manufacturer?  You would think with that many clotting off there is something in common.  What does you medical director have to say?

We have also had a drop in our census.  12 chair clinic, down to 34 patients.  I don't know that we've lost more than usual, but we aren't getting new patients.  The rest of the clinics in our area also have low censuses.  We only have two nurses for a 6 day a week clinic and they wanted to cut us back from 4 to 3 days, but we already don't get our hours and our CM is leaving next month and no replacement is hired so they're letting us keep our 4 days for now.  We'll see what happens.

Hope you get some answers!

[scootersuz, ASN]

Hmm, we aren't giving less heparin. If anything our doses have increased.  Same manufacturer. Maybe the quality has changed or inaccurate. Even our catheters are clotting more frequently so we increased the concentration on our heparin catheter locks.  The medical director hasn't weighed in and the NP is also quite puzzled. They both rotate through several clinics in our two counties. It's a widespread issue here. 
Our acute nurse said she learned that there is also a nationwide shortage of dialysis catheters.  Wondering if that means this is happening other places too or maybe that's just a supply constraint. 
Sounds like you slowed down too but maybe for better reasons and not needing dialysis. Either that or the pts aren't making it long enough to get discharge and get dialysis. Then there is the push for home hemo which is good if it is a fit. That's not what happening here Though. Thanks for your reply ?

 

 

 

 

[kbrn2002, ADN, RN]

We've had an uptick in catheters as well. Partly because our clinic has several new to dialysis patients that have not have arm access placed yet. Partly because some of those newer patients that have had arm access placed the access isn't maturing as expected. We do have a few catheter patients that are just not interested in an arm access for whatever reason. But right now a big issue for us il lack of providers. The vascular clinics are down surgeon's, one of our primary clinics is down to one from 3 with no relief in sight. IR has had to do most of our recent CVC placements as well as AVF/AVG revisions.

[Guttercat, ASN, RN]

There might be a correlation to a possible causation (which shall be unnamed). 

Maybe create a hypothesis based on observation, and do a little digging and data collection? Could be an interesting project.