NKF dialysis centre nurses can unblock catheters, saving diabetic patients trips to hospital

  When kidney failure patients’ dialysis catheter is blocked, they usually visit hospitals for treatment. This can take three to six days of hospitalisation, with dialysis disrupted as well.

  However, a new service by Singapore General Hospital (SGH) and the National Kidney Foundation (NKF) allows patients to have their catheter unblocked at NKF dialysis centres — and to resume dialysis on the same day.

  Dr Tan Ru Yu, Senior Consultant, Department of Renal Medicine, SGH, and the project’s co-lead, said: “With the right-siting of care, patients can receive treatment for their blocked catheters at the dialysis centre they go to and proceed with dialysis at the centre right after without having to make their way to the hospital. Our  partnership with NKF has also enabled SGH to focus on complex cases requiring immediate attention.”

  In Singapore, over 300,000 patients suffer from chronic kidney disease, but another 200,000 cases may be undetected as the patients have not undergone the blood  tests needed to confirm that they have a kidney problem. Nationwide, about 8,700 kidney failure patients are on dialysis, with six new patients diagnosed every day.

  The kidneys are important organs that remove excess fluids and toxins, control blood pressure, and encourage the production of red blood cells. When the kidneys fail and cannot do their work properly, dialysis can perform the function of removing excess fluids and toxins from the body. Fluid and toxin buildup can lead to death.

  In haemodialysis, an access has to be created for the blood to be drawn. Some patients use a central venous catheter inserted into a large vein in the neck, chest, or groin for dialysis to be done. The catheter can become blocked due to the formation of blood clots.

  When this occurs, patients are usually referred to hospitals’ emergency department. They are then admitted to a ward and administered with thrombolytic agents to break up or dissolve the blood clots. These patients would then need to wait for an available slot for dialysis at the hospital. If dialysis is successful, the patient is discharged the following day, which means an average hospital stay of three days  .

  If the blood is still not flowing smoothly through the catheter after the procedure, the patient will have to undergo a catheter replacement and dialysis before being discharged. With the waiting times for the various procedures, the patient’s hospital stay can be as long as six days .

  In addition to delayed haemodialysis and disruption to a patient’s routine, a trip to the hospital means additional travel time and hospitalisation costs. For the hospital, such cases add to congestion and care demands at the emergency department. SGH sees about 100 patients yearly for blocked catheters.

  The SGH-NKF Catheter Flow Restoration with Lytic Dwell at Community Dialysis Centre project (CLEAR) was launched in December 2022. Since then, SingHealth nephrologists have trained more than 100 NKF nurses to administer the treatment, said Ms Lucy Lu, Senior Nurse Manager, NKF. The doctors training the nurses include Dr Tan, Dr Pang Suh Chien, Senior Consultant, Department of Renal Medicine, SGH, and Dr Charles Ng, Associate Consultant, Renal Medicine  Department, Changi General Hospital (CGH).

  NKF, the largest dialysis provider in Singapore, operates 41 centres for some 4,642 patients, or 60 per cent of all haemodialysis patients in Singapore. Of these, more than 700 patients undergo dialysis via a central venous catheter. Before the implementation of CLEAR, some 50 patients were referred to a hospital every month for catheter flow issues.

  Patients keen to participate in the project are screened for  eligibility based on criteria like risk of bleeding. Patients not on the programme will continue to be referred to emergency departments for catheter blockage.
  Other public hospitals — CGH, Alexandra Hospital, Khoo Teck Puat Hospital, National University Hospital, Ng Teng Fong General Hospital, Sengkang General Hospital and Tan Tock Seng Hospital — have joined the service, which is supported by the Ministry of Health.