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Kidney Week

Abstract: PO0995

Assessing Physician Clinic Practices and Competencies in Performing Peritoneal Dialysis Catheter Flushes During the 10-Day Global Period

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Crabtree, John H., Harbor-UCLA Medical Center, Torrance, California, United States
  • Pecora, Marcus, DaVita Inc, Denver, Colorado, United States
  • Shapiro, Mark H., Balboa Nephrology Medical Group, San Diego, California, United States
  • Zanatta, Eduardo, DaVita Inc, Denver, Colorado, United States
  • Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
Background

Early flushing of peritoneal dialysis (PD) catheters theoretically reduces the incidence of catheter obstruction by decreasing formation of fibrin strands or blood clots. Early flushing also enables timely identification of catheter dysfunction, creating an opportunity to revise the catheter prior to scheduled training and initiation of therapy. It is unknown how frequently PD access providers perform flushes in their clinics, but Centers for Medicare & Medicaid Services (CMS) has indicated that services performed within 10 days following catheter placement (global period) are the responsibility of PD access providers. Therefore, under existing regulations, dialysis organizations generally defer to access providers to perform catheter flushes during this global period. The purpose of this study is to assess current practices of PD access provider clinics (surgeon, interventional nephrologist or radiologist) in performing catheter flushes.

Methods

PD access providers placing catheters for a large dialysis organization in the southwestern United States during 2020 were surveyed. The 3-question survey asked 1) PD access provider specialty, 2) if the clinic performed catheter flushes, and 3) the background of the staff person assisting the physician with clinic procedures. Responses were acquired by direct or telephone contact with the physician or clinic staff.

Results

Survey responses were obtained for all 201 providers who placed PD catheters during 2020 (Table).

Conclusion

Significantly, none of the PD access provider clinics elected to perform catheter flushes. This lack of service may indicate a lack of expertise or readily accessible supplies. While PD nurses are trained and equipped by dialysis organizations to competently perform catheter flushes, current regulations generally prevent them from providing these services during the global period. The survey supports a re-examination of the CMS policy, suggesting a need for more flexibility for dialysis organizations to provide these services during the global period for patient safety and optimal patient outcomes.

Funding

  • Commercial Support