Abstract: SA-PO962
Utilizing a Multidisciplinary Approach to Lower the Central Venous Catheter Rate Among Chronic Hemodialysis Patients: A Quality Improvement Project
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Husain, Irma, James J Peters VA Medical Center, New York, New York, United States
- Shaikh, Aisha, James J. Peters Medical Center VA, New York, New York, United States
Background
United States Renal Data System (USRDS) evidence shows that the number of Central Venous Catheter (CVC) dependent patients is 20% and 12% after 1 and 2 years of hemodialysis (HD) initiation respectively. At our hospital, the CVC dependence among chronic hemodialysis patients remains very high. Therefore, we sought to determine if a multi-disciplinary approach, involving the Nephrologists, Interventional Radiologists, and the Vascular Surgeons could reduce CVC use in long-term HD patients.
Methods
From August 2016 to July 2017, we identified 26 CVC-dependent long-term HD patients, 73% of who had a history of at least one failed Arterio-Venous (AV) access. The Interventional Nephrologist reviewed their records including comorbidities, access failure and complications history and venograms or fistulograms. This data was then presented at monthly multi-disciplinary meetings, also attended by Interventional Radiologists and Vascular Surgeons, during which, potential AV access options including arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) were discussed in detail. A viable AV access option was then identified and placed after discussion with the patient.
Results
27% (7/26) patients developed a functional AV access. Of these 57% (4/7) were AVGs, 29% (2/7) were AVFs and 14% (1/7) were HeRO (Hemodialysis Reliable Outflow) grafts.
46% (12/26) patients were not able to receive an AV access due to severe peripheral vascular disease or poor overall prognosis while 27% (7/26) patients died through the course of the year.
Conclusion
Monthly multi-disciplinary vascular access meetings with an individualized approach led to an increase in the prevalence of AV accesses among chronic HD patients. We impress that AVG and HeRO graft creation should be considered in patients who are poor candidates for an AVF, as any functional AV access leads to a reduction in CVC dependence and its related complications.
Fig.1 Outcomes