Practice of peritoneal dialysis catheter flushing in Australia and New Zealand: multi-center cross-sectional survey

Background: Evidence of effective interventions to preventperitoneal dialysis (PD) catheter malfunction before first use ispresently insufficient to guide clinical care. Regular flushing ofthe PD catheter (e.g. before PD commencement) has been adoptedby some practitioners in the belief that it will prevent catheterobstruction and/or malfunction. The aim of this study was tocharacterize and evaluate PD catheter flushing practices acrossAustralian and New Zealand PD units.Methods: An on-line survey was distributed to all 62 PD unitsin Australia (12 August 2016; n = 51) and New Zealand (2 February2017; n = 11), with questions relating to PD catheter flushingpractices, audit, and outcomes.Results: Forty-nine units of variable size ( 100 patients)completed the survey (79% response rate). All centers flushed PDcatheters at some stage after insertion as routine unit practice.Forty-one units (84%) routinely flushed during periods of PD restat varying intervals ranging from alternate daily to monthly. Thetype and volume of solution used to flush varied between units.Units that practised routine flushing of PD catheters were almosttwice as likely to audit their catheter-related outcomes (66% vs38%, p = 0.23) and more likely to have reported blocked cathetersin the preceding 12 months (84% vs 0%, p = 0.01) compared withthose units that did not routinely flush PD catheters. Thirty units(61%) regularly audited and monitored catheter-related outcomes.Conclusions: This study identified a wide variation in centerpractices relating to PD catheter flushing. Drawing conclusionsabout any relationship between flushing practices and clinicaloutcomes was impeded by the relatively low uptake of regularauditing and monitoring of catheter-related outcomes across surveyedunits. Evaluation of the benefits and harms of standardizedPD catheter flushing practices on patient outcomes in a randomizedtrial is needed to guide practice