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C ath A way fistula vascular access program achieves improved outcomes and sets a new standard of treatment for end‐stage renal disease
Author(s) -
Wilson Steven M.,
Mayne Tracy J.,
Krishnan Mahesh,
Holland Janet,
Volz Abbe,
Good Lori S.,
Nissenson Allen R.
Publication year - 2013
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00721.x
Subject(s) - medicine , end stage renal disease , vascular access , hemodialysis , arteriovenous fistula , intensive care medicine , hemodialysis access , disease , fistula , surgery
Hemodialysis patients using central venous catheters ( CVCs ) for vascular access are at greater risk of infection and death vs. arterial venous fistula ( AVF ). In 2008, D a V ita initiated the C ath A way quality improvement initiative, a multidisciplinary program to reduce CVC use in favor of AVF . Our retrospective analysis examined CVC use for incident (≤90 days) and prevalent (>90 days) patients receiving hemodialysis in the years 2006 to 2010. Outcomes included annual mean percentage of patients with CVCs , new CVC placements per 100 patient years, CVC survival, and percentage patient days with CVC . Over 152,000 patient records were reviewed. Between 76.2% and 79.7% of incident patients used a CVC annually, but for prevalent patients, the proportion decreased from 41.1% in 2006 to 33.5% in 2010. The number of new CVC placements per 100 patient years increased slightly for incident patients but fell annually from 64.8 in 2006 to 55.2 in 2010 for prevalent patients. The percentage of treatment days with CVCs was stable among incident patients (70.4%–74.3%) but fell among prevalent patients from 26.1% in 2006 to 16.5% in 2010. The mean duration of CVC use in incident patients was between 53.0 days ( SD , 27.8) in 2006 and 54.1 days ( SD , 28.1) in 2009, and for prevalent patients between 158.9 days ( SD , 123.0) in 2006 and 128.1 days ( SD , 112.0) in 2010. C ath A way significantly decreased CVC use in prevalent hemodialysis patients. Decreasing incident patient use will require improvements in predialysis care.