HHE Standards of care in haemodialysis catheters - Page 3

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On 10 May 2021 , nephrologists and nephrology nurses from six countries gathered to explore the benefits and barriers for patients , healthcare workers and hospitals of arteriovenous fistulas / grafts versus central venous catheters in haemodialysis . Their discussion aimed to understand the factors involved in choosing lock solutions for dialysis catheters . They analysed the evidence base for the clinical benefits of ClearGuard™ HD and proceeded to share insight into how best to communicate its clinical benefits .
Choosing between arteriovenous fistula and central venous catheters for haemodialysis The guidelines and recommendations on haemodialysis practices have highlighted the superiority of arteriovenous catheters ( AVF ), compared to central venous catheters ( CVC ), due to fewer infections , complications , and reduced morbidity . The high cost incurred by CVCs results from high incidences of central line-associated bloodstream infections ( CLABSIs ), as well as catheter dysfunction and occlusion .
Despite the initial implantation cost , AVF is thought to incur a lesser overall cost to patients and healthcare systems by reducing demand for medications and hospital visits or admissions . Particularly , in the US , if infection rates are higher than the national average this could impede financial reimbursement in subsequent years .
Across Europe , CVC usage has been generally reported in 20-30 % of haemodialysis patients ; yet , despite the high incidence of complications , CVC usage is increasing . Healthcare professionals attribute this rise to an ageing population with increasing rates of comorbidities , late-stage disease , and a shorter life expectancy . HCPs emphasise that for patients prioritising quality of life , such as those in end-of-life care , the less invasive nature of CVCs is more appealing . >
BOX 1
Summary of benefits of AVF vs CVC
AVF
• Lower incidence of infection
• Fewer complications
• Fewer hospitalisations
• Less morbidity
• Greater patient freedom
CVC
• Less invasive for elderly or frail patients
• Greater QoL for palliative care
• Allow immediate dialysis for acute kidney care e . g ., prior to transplant
• Better for needle-phobic patients
The sicker patients in many instances have a life expectancy of around a year or less and , in these cases , the patients prefer to put quality of life first Martin Kuhlmann