Mrs MARGARET GOLDING1
1SYDNEY LOCAL HEALTH DISTRICT, CAMPERDOWN, AUSTRALIA
Biography:
Margaret Golding delivers a nurse-led service focused on educating patients and their families about the management of chronic kidney disease (CKD) and renal replacement therapy options. These include kidney transplantation, peritoneal dialysis, haemodialysis, and renal supportive care, provided through both individual consultations and group education sessions.
Margaret has presented at national and international renal and vascular conferences and was invited to Vietnam to deliver an intensive week-long education program for haemodialysis nurses and physicians.
Abstract:
Background
Tunnelled central venous catheters (CVC) are often used for haemodialysis when vascular access is limited but frequently thrombose, leading to repeated replacements. Evidence-based treatments are usually available only at tertiary centres, where early referral may reduce complications, preserve access, and improve patient outcomes.
Case Description
A 40-year-old woman developed interstitial nephritis secondary to sulfasalazine and commenced haemodialysis via a tunnelled CVC at a satellite unit. Over eight months, she required 10 catheter replacements due to recurrent thrombotic occlusions. Management relied on catheter exchange and warfarin, with limited access to evidenced based patency-restoration strategies.
Following referral to a tertiary centre, she received weekly dialysis sessions in addition to her satellite unit treatments. Urokinase was used as an intraluminal lock before and after dialysis and left in place until the next session.
Discussion
After commencing this regimen, the patient had no further catheter occlusions or replacements over five months, until her planned living donor renal transplant. This case shows that specialised tertiary-centre interventions can prevent recurrent CVC thrombosis, with early referral enabling timely, evidence-based care that reduces complications and preserves venous access.
Conclusion
Early referral to tertiary dialysis centres enables timely evidence-based care, reducing tunnelled CVC complications, limiting catheter replacements, preserving vascular access, and improving dialysis efficiency and patient experience.