Vol. 7, Issue 2, Part A (2025)

End-stage kidney disease (ESKD) poses a significant and growing health burden in India, where late presentation and limited vascular access planning often necessitate the use of central venous catheters (CVCs) for haemodialysis initiation. Although the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend arteriovenous (AV) fistulas as the preferred vascular access, up to 80% of Indian patients begin dialysis with CVCs, which substantially increases the risk of catheter-related bloodstream infections (CRBSI) and mortality. This study assessed central venous access care (CVAC) practices across dialysis facilities in India, focusing on adherence to international guidelines and identifying variations in protocols.

A descriptive cross-sectional design was employed in seven dialysis centres representing different regions of India. Data were collected through direct observation of CVC procedures, facility record reviews, and interviews with nephrologists, nurses, and dialysis technicians. A 12-item checklist based on KDOQI 2019 guidelines was used to evaluate adherence during CVC access and exit-site care.

Findings revealed considerable variability in vascular access practices and infection prevention protocols across facilities. Only 55.7% of patients had AV fistulas, with reliance on temporary or permanent CVCs ranging from 10% to 95% between Centres. Antiseptic use for CVC care differed, with only 2 of 7 facilities using 2% chlorhexidine as recommended; povidone-iodine and spirit were more commonly used. Exit-site dressing frequency, type of occlusive dressing, and use of antibiotic barriers also varied. Overall adherence to guidelines averaged 67% (range: 53.8-83.9%), with strong compliance in mask use and sterile dressing but poor documentation of CVC assessments and CRI rates.

These findings underscore the urgent need for standardized operating procedures, competency-based training, and improved resource utilization to optimize CVAC practices. Strengthening adherence to evidence-based guidelines could significantly reduce infection-related morbidity and mortality among patients receiving haemodialysis in India.