Learning why patients with central venous catheters resist permanent access placement.

Central venous catheters (CVCs) are a well-known risk to patients on hemodialysis due to their higher morbidity and mortality compared to fistulas or grafts. One factor in the prevalence of CVCs is patients eligible for permanent access who refuse referral and permanent access placement. Objectives of this study were to identify reasons patients resist permanent access placement and develop potential strategies for intervention. A survey was distributed to Fresenius Medical Care North America (FMCNA) outpatient dialysis facilities (approximately 1600 facilities) requesting voluntary participation in documenting reasons given by patients for resisting permanent access placement. From the patient survey results, responses were collected and ranked from most frequent response to least frequent response. A collaborative workgroup of nephrology nurses and social workers reviewed the survey results. The patient survey provided 1573 responses. The three most frequently provided reasons were 1) a previous negative surgical experience, 2) having a permanent access placed in the past that did not work, and 3) cannulation fear and/or pain concerns. The workgroup identified best practices from clinics with low CVC rates and reviewed professional literature as a guide for development of potential strategies for intervention by the nephrology nurses and interdisciplinary team. Using a patient survey as a means to learn reasons why patients resist permanent access placement can be of value to the healthcare team in the development of potential strategies for interventions to reduce CVC utilization and thereby improve patient outcomes.