Nurses in intensive care units across China face a tough choice. They must decide when to remove temporary tubes used for kidney dialysis. A recent survey of 704 nurses in 30 provinces looked at how they make these decisions. The results show a clear pattern in their daily work. Most nurses remove the catheter when it is no longer required for clinical treatment. This happens in about 58 percent of cases. However, the leading reason to keep the tube is a high risk of bleeding for the patient. This occurs in nearly 45 percent of situations. The team also found that doctors usually decide on removal and perform the procedure. About 66 percent of nurses said physicians handle both the decision and the action. Despite this, 89 percent of nurses support checking daily if the catheter is still needed. This daily check helps ensure the tube is not left in longer than necessary. The study notes that because it was exploratory, the team did not adjust for multiple comparisons. This means some numbers might vary if studied differently. Still, the findings highlight a need for standardized nursing protocols.
ICU nurses in China report femoral vein as the preferred site for temporary hemodialysis catheter removalICU nurses in China mostly agree on removing kidney catheters when they are no longer needed
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Key Takeaway
Consider standardized nursing assessment protocols for temporary hemodialysis catheter removal in ICU settings.
This multicenter cross-sectional study evaluated current practices and associated evaluation factors regarding temporary hemodialysis catheter removal among ICU nurses. The survey included 704 participants from 30 provinces in China, representing 32 provincial-level regions. The study aimed to understand the indications for removal, reasons for retention, and decision-making responsibilities within this specific population.
The most frequently reported indication for catheter removal was that the device was no longer required for clinical treatment, reported by 394 of 681 respondents (57.86%). Conversely, the leading reason for temporary catheter retention after CRRT cessation was high patient bleeding risk, cited by 284 of 635 respondents (44.72%).
Regarding decision-making and procedure performance, physicians held responsibility for removal decisions in 463 of 704 cases (65.77%) and performed the procedure in 471 of 704 cases (66.9%). The femoral vein was the preferred insertion site for 515 of 680 respondents (75.74%). Daily assessment of catheter retention necessity was supported by 629 of 704 nurses (89.35%).
The authors noted that the basis for judging removal eligibility relied on laboratory test results or clinical experience in over 80% of cases. Formal training on catheter removal was received by 55.4% of respondents. Given the exploratory nature of this study, the authors did not adjust the significance level for multiple comparisons. Standardized nursing assessment and recommendation protocols are urgently needed.
What this means for you:
Most nurses remove catheters when treatment ends, but bleeding risk often delays removal. View Original Abstract ↓
BackgroundEstablishing temporary vascular access is essential for critically ill patients undergoing continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). However, such access increases the risk of catheter-related complications, which may exacerbate clinical conditions and even threaten patient survival. This study aimed to investigate current practices and associated evaluation factors regarding temporary hemodialysis catheter removal among Chinese ICU nurses, to clarify why catheters are often retained for prolonged periods after CRRT discontinuation and when removal is typically performed.MethodsA multicenter, cross-sectional questionnaire survey was conducted among ICU nurses across 30 provinces in China. Data were collected on current practices related to temporary blood purification catheter removal. Chi-square tests were used to compare practices and evaluation factors among nurses with different characteristics. Given the exploratory nature of this study, we did not adjust the significance level for multiple comparisons.ResultsA total of 704 ICU nurses from 32 provincial-level regions in China were included, with 50.14% (353/704) from Central China. The most frequently reported indication for catheter removal was “no longer required for clinical treatment” (394/681, 57.86%). Missing data in ranking questions were handled by pairwise deletion, with percentages calculated only from valid responses. The leading reason for temporary catheter retention after CRRT cessation was “high patient bleeding risk” (284/635, 44.72%). For functionally intact catheters, 65.34% (460/704) of nurses determined removal based on assessment results. The femoral vein was the preferred insertion site (75.74%, 515/680). Daily assessment of catheter retention necessity was supported by 89.35% (629/704) of nurses. Over 80% of respondents judged removal eligibility based on laboratory test results or clinical experience. Physicians were primarily responsible for removal decisions (65.77%, 463/704) and performance of the procedure (66.9%, 471/704). Only 55.4% of nurses had received formal training on catheter removal. Significant differences were observed in removal timing, retention reasons, and management among nurses with different professional characteristics.ConclusionICU nurses in this study demonstrated heterogeneous practices and evaluation criteria for temporary CRRT catheter removal, guided mainly by personal clinical experience and local departmental protocols. Only approximately half of the nurses had received relevant training, and no consensus existed regarding optimal timing and duration for catheter removal. Standardized nursing assessment and recommendation protocols are urgently needed.
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