Abstract:
Background: The tunnelled haemodialysis catheter (TDC) removal is a necessary skill for the nephrology trainee as this task is undertaken routinely in renal units. Little published data exists to establish current practice and there is no national guidance regarding TDC removal in United Kingdom (UK). Anecdotally, trainees suggest they do not have sufficient supervised training in TDC removal. We aimed to establish the differences in training and practice in TDC removal among nephrology trainees across UK.
Method: We created an online survey with twenty questions for trainee and non-training nephrology registrars working in UK. The survey was distributed via regional renal training programme directors, UK Kidney Association, “Renal SpR Club” and online professional social networks including social media and instant messaging services.
Results: We received 75 responses from all of 14 postgraduate training deaneries. 91% reported renal registrars remove TDCs in their units. 53% of the operators were taught by another registrar. Only 16% report awareness of written local trust guidance on TDC removal. 43% reported removing > 10 TDCs a year. Cut-down method is preferred over traction method for TDC removal. 63% remove TDCs in designated procedure areas, 52% obtain written consent and 65% wear full sterile personal protective equipment (PPE). 16% report removing TDCs alone with no assistant and 12% do not stop aspirin, antiplatelets or anticoagulants beforehand. 30% of operators reported experiencing a “stuck catheter” at some point in their careers.
Conclusions: This survey highlights that TDC removal is a common procedure and predominantly performed by renal physicians in teaching hospitals. It is mostly undertaken by registrar level doctors often without formal training or written guidelines with varying techniques. 68% of participants want this procedure to be part of mandatory training in the renal post graduate training curriculum.
Reference:Boral I, Srivastava S, McKinnell J. Differences in training and practice in tunnelled haemodialysis catheter removal: a survey of nephrology trainees across United Kingdom. BMC Nephrol. 2025 Mar 6;26(1):124. doi: 10.1186/s12882-025-04034-1. PMID: 40050800.