Abstract: SA-PO961
Surveillance of Catheter Conversion (CC) and Future Vascular Access (VA)
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
- Sands, Jeffrey J., Vasc-Alert LLC, Evanston, Illinois, United States
- Kumbar, Lalathaksha Murthy, Henry Ford Health System, Troy, Michigan, United States
- Hirschman, Kim, Vasc-Alert LLC, Evanston, Illinois, United States
- Frinak, Stanley, Henry Ford Health System, Troy, Michigan, United States
- Zasuwa, Gerard, Henry Ford Health System, Troy, Michigan, United States
- Kennedy, John B., Vasc-Alert LLC, Evanston, Illinois, United States
Background
We evaluated the impact of AV access (AVF or AVG) conversion (CC) to a central venous catheter (CVC) on patients future VA. Recent efforts focus primarily on AVF placement and maturation. VA outcomes including the extent of CVC use post access complications are less appreciated.
Methods
We identified CC from downloaded treatment (Tx) records utilized for Vasc-Alert™ VA surveillance from 1/1/14—6/30/17 in patients (pts) using a single AV access from 10/2013-12/2013. CC was defined as a recorded change to a CVC for ≥4 Tx within 30 days. Missed treatments were identified from Tx records gaps.
Results
Data included 1,598,680 Tx from 4923 pts (76.1% AVF; 23.9% AVG); mean age 61.1±14.5 yrs (60.6±14.6 AVF; 62.8±14.3 AVG), mean vintage 4.1±3.8 yrs (3.8±3.5 AVF; 5.0±4.6 AVG) in 137 facilities (10 dialysis providers). CC occurred in 16.7% (820/4923) of pts (13.1% AVF, 28.1% AVG; P<0.001); CC rate: 8.2/100 pt-yrs (6.2 AVF; 15.5 AVG). At 1 yr, mean CVC exposure was 168.1 days/pt-yr (162.8 AVF; 176.6 AVG). Vasc-Alert™ provided an alert prior to CC in 57.2% (52.9% AVF; 63.6% AVG). Missed Tx (%) were greater in AVG (P<0.001) and similar in non-CC (4.8% Tx; 4.6% AVF; 5.5% AVG) and pre-CC pts (4.7%; 4.5% AVF, 5.1% AVG)(P=NS). Missed Tx then increased post-CC (6.4%; 5.7% AVF; 7.3% AVG)(P<0.001). Post CC, 52.9% were CVC dependent at 3 months, 33.9% at 6 months and 21.3% at 1 year. Only 23.9%, 27.7% and 30.1% returned to their original VA at 3, 6 and 12 months respectively and 44.3% had a new AV access at 1 yr.
Conclusion
CC results in prolonged CVC use in a high percentage of HD patients. Only ~30% of patients returned to their original access and >44% had a new AV access at 1 year. CC was more frequent in AVG, led to significantly more missed Tx and catheter exposure of >168 days/pt-yr. These data emphasize the importance of access surveillance and preventing terminal access failure to decrease CVC prevalence.
Access in Use Post CC
| Pre-CC VA | AVF | AVG | Total | ||||||
| Post CC VA | 3 m | 6 m | 12 m | 3 m | 6 m | 12 m | 3 m | 6 m | 12 m |
| N | 448 | 412 | 349 | 304 | 284 | 242 | 752 | 696 | 591 |
| Original AV Access (%) | 24.8 | 28.9 | 30.1 | 22.7 | 26.1 | 30.2 | 23.9 | 27.7 | 30.1 |
| New AV Access (%) | 20.8 | 35.4 | 47.0 | 18.1 | 33.8 | 40.5 | 19.7 | 34.8 | 44.3 |
| CVC (%) | 51.6 | 32.8 | 18.9 | 54.9 | 35.6 | 24.8 | 52.9 | 33.9 | 21.3 |
| Mean CVC days/ patient | 69 ± 26 | 109 ± 63 | 162 ± 127 | 69 ± 27 | 112 ± 65 | 175 ± 135 | 69 ± 27 | 110 ± 63 | 167 ± 130 |
Funding
- Commercial Support – Vasc-Alert LLC