Singapore, 13 October 2023 — Haemodialysis patients no longer need to go to the hospital for blocked central venous catheters (CVC), thanks to a new partnership between Singapore General Hospital (SGH) and The National Kidney Foundation (NKF) that has right sited care to the community. 

SGH has developed a clinical protocol and a train-the-trainer framework which allows NKF to train its nurses in administering the treatment to clear patients’ CVC when blocked. To date, a total of 100 nurses across all dialysis centres have been trained, which have benefited 23 NKF patients since the initiative was implemented in December 2022.

Dr Tan Ru Yu, Senior Consultant, Department of Renal Medicine, SGH and project 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.” 

Co-leading this project is Associate Professor Jason Choo, NKF’s Medical Director, and also Dr Tan’s colleague in the same department in SGH. 

The CVC, which is inserted into a large vein in the neck, chest, or groin, removes waste products and extra fluid during dialysis. When it is blocked, patients will be directed to a hospital’s emergency department for a “clot-busting” drug known as thrombolytics, which is injected into the catheter to break up and dissolve the clots. Otherwise, it can be dangerous for patients as the consequences are fatal when toxins build up in the body without dialysis. SGH sees about 100 patients yearly for blocked catheters.

If NKF nurses assessed that patients require specialist treatment instead, there is an established workflow in the clinical protocol to refer them to their hospital promptly. 

“We understand the challenges this may pose for our patients. With a dedicated team of well- trained nurses, we can systematically implement this procedure across all 41 of our dialysis centres, ensuring minimal disruptions to their treatment and a smoother overall care experience,” explained Ms Pauline Tan, Deputy Director, Nursing Services, NKF.

Dialysis is the most common form of treatment for patients with kidney failure. According to the Singapore Renal Registry, there are currently about 8,700 kidney failure patients in Singapore, with six new patients diagnosed every day. While there is no local statistics on the number of patients using CVC for haemodialysis, more than 700 patients (15%) at NKF rely on this method.   

The SGH-NKF partnership is supported by the National Improvement Unit as an initiative under the Ministry of Health’s National Diabetes Collaborative. Other public hospitals, namely Alexandra Hospital, Changi General Hospital, Khoo Teck Puat Hospital, National University Hospital, Ng Teng Fong General Hospital, Sengkang General Hospital, and Tan Tock Seng Hospital, are now on board, screening their renal patients who may be eligible.