Cho Yeoungjee, Boudville Neil, Palmer Suetonia C, Chow Josephine S F, Hawley Carmel M, Jose Matthew D, MacGinley Rob, Huang Louis, Moodie Jo-Anne, Nguyen Thu, Robison Laura, Wong Jeffrey, Johnson David W
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
Perit Dial Int. 2018 Mar-Apr;38(2):98-103. doi: 10.3747/pdi.2017.00108. Epub 2017 Nov 2.
Evidence of effective interventions to prevent peritoneal dialysis (PD) catheter malfunction before first use is presently insufficient to guide clinical care. Regular flushing of the PD catheter (e.g. before PD commencement) has been adopted by some practitioners in the belief that it will prevent catheter obstruction and/or malfunction. The aim of this study was to characterize and evaluate PD catheter flushing practices across Australian and New Zealand PD units.
An on-line survey was distributed to all 62 PD units in Australia (12 August 2016; = 51) and New Zealand (2 February 2017; = 11), with questions relating to PD catheter flushing practices, audit, and outcomes.
Forty-nine units of variable size (< 16 to > 100 patients) completed the survey (79% response rate). All centers flushed PD catheters at some stage after insertion as routine unit practice. Forty-one units (84%) routinely flushed during periods of PD rest at varying intervals ranging from alternate daily to monthly. The type and volume of solution used to flush varied between units. Units that practised routine flushing of PD catheters were almost twice as likely to audit their catheter-related outcomes (66% vs 38%, = 0.23) and more likely to have reported blocked catheters in the preceding 12 months (84% vs 0%, = 0.01) compared with those units that did not routinely flush PD catheters. Thirty units (61%) regularly audited and monitored catheter-related outcomes.
This study identified a wide variation in center practices relating to PD catheter flushing. Drawing conclusions about any relationship between flushing practices and clinical outcomes was impeded by the relatively low uptake of regular auditing and monitoring of catheter-related outcomes across surveyed units. Evaluation of the benefits and harms of standardized PD catheter flushing practices on patient outcomes in a randomized trial is needed to guide practice.
目前，关于在首次使用前预防腹膜透析（PD）导管故障的有效干预措施的证据不足，无法指导临床护理。一些从业者采用定期冲洗PD导管（如在开始腹膜透析之前）的方法，认为这样可以防止导管阻塞和/或故障。本研究的目的是描述和评估澳大利亚和新西兰各腹膜透析单位的PD导管冲洗操作。
向澳大利亚所有62个腹膜透析单位（2016年8月12日；n = 51）和新西兰所有11个腹膜透析单位（2017年2月2日）发放了一份在线调查问卷，问题涉及PD导管冲洗操作、审核及结果。
49个规模各异（<16至>100例患者）的单位完成了调查（回复率79%）。所有中心在导管插入后的某个阶段都会按照单位常规操作冲洗PD导管。41个单位（84%）在腹膜透析休息期间定期冲洗，冲洗间隔从隔天到每月不等。各单位用于冲洗的溶液类型和体积各不相同。与未常规冲洗PD导管的单位相比，常规冲洗PD导管的单位对导管相关结果进行审核的可能性几乎是其两倍（66%对38%，P = 0.023），并且在过去12个月中报告导管堵塞的可能性更高（84%对0%，P = 0.01）。30个单位（61%）定期审核和监测导管相关结果。
本研究发现各中心在PD导管冲洗操作方面存在很大差异。由于在接受调查的单位中，对导管相关结果进行定期审核和监测的比例相对较低，因此难以就冲洗操作与临床结果之间的任何关系得出结论。需要通过一项随机试验评估标准化PD导管冲洗操作对患者预后的利弊，以指导临床实践。
