Dr Amanda Corley1,2,3, Dr Lucy Shinners1,3, Professor Nicole Marsh1,3,4, Emily Larsen1,3, Catherine O’Brien3, Professor Melissa Bloomer1,5
1School of Nursing and Midwifery, Griffith University, Brisbane, Australia, 2Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia, 3Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 4School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia, 5School of Nursing and Midwifery, La Trobe University, Brisbane, Australia
Biography:
Dr Shinners is a Research Fellow at The University of Queensland’s Infection Prevention and Vascular Access Device group and a clinician‑researcher with 25 years of ICU nursing experience. Her work examines how emerging technologies can strengthen safe, high‑quality and culturally responsive care. Using a sociotechnical lens, she studies how artificial intelligence shapes workforce practice, decision‑making and safe adoption. She collaborates with Indigenous health organisations to co‑design community‑led technological solutions and infection prevention and vascular access safety, exploring AI‑enabled approaches for risk prediction, surveillance and improved clinical governance.
Abstract:
Introduction
In Australian intensive care units (ICU), approximately 9,000 patients require renal replacement therapy (RRT) annually for acute kidney injury, with nearly one third of these dying before ICU discharge. RRT requires a large-bore dialysis catheter (DC) to facilitate effective extracorporeal blood flow, however they have the highest failure rate (7–20%) of all central venous catheters used in ICU. Evidence informs catheter insertion and therapy modes, yet guidance for ongoing post‑insertion care is limited. This study explores ICU nurses’ experiences managing DCs, focusing on how existing policies and bedside practices influence nurses’ decision making.
Methods
A qualitative, descriptive design grounded in naturalistic inquiry was used. Registered nurses with experience caring for patients undergoing dialysis were eligible to participate. Data were collected through small group, semi-structured interviews and were analysed using inductive content analysis.
Results
Eighteen clinicians participated across three focus groups, with an average of 11.2 years’ experience in DC care. Two major themes were identified: (1) Troubleshooting is complex, characterised by: a reliance on experiential knowledge in the absence of policy, time sensitive decision making, and balancing patient risk versus benefit; and (2) The hidden cost, reflecting the stress, unrecognised labour and financial burden associated with troubleshooting catheter dysfunction.
Conclusion
The absence of clear DC troubleshooting policy places substantial burden on ICU nurses. Developing evidence-based guidance to manage catheter dysfunction could improve dialysis efficiency, lower healthcare-associated risks, reduce workforce stress, and mitigate the clinical and financial consequences of catheter failure.