Back to the Basics:

Increasing the Use of Arterial Venous Fistulas

In Hemodialysis Patients

 

Quality Initiative Summary

 

“Back to the Basics” addresses the national ESRD Program priority of maximizing placement and use of arterial venous fistulae (AVF) in hemodialysis patients. Northwest Renal Network’s Medical Review Board chose this project for the 2002/2003 contract year after reviewing three vascular access quality improvement project templates designed by the Centers for Medicare and Medicaid Services (CMS)-sponsored Vascular Access Workgroups: Increasing Use of AV Fistulas, Decreasing Catheter Use, and Monitoring for Stenosis.

 

Northwest Renal Network analyzed data from the Centers for Disease Control and Prevention National Surveillance of Dialysis-Associated Diseases 2000 and 2001 surveys. Aggregated data indicates that in December 2001, close to 44% of hemodialysis patients in our Network were using an AV fistula for access. Overall, this meets the DOQI Access Guideline #29. However, there is substantial variation among our individual facilities, with some units achieving as high as 90% of patients utilizing AVFs, while at other facilities less than 20% of patients use AVFs. Existing data points to an opportunity to increase the placement of AV fistulas in both incident and prevalent hemodialysis patients at selected Network facilities.Several of these facilities also have a high proportion of patients with permanent catheters. Intervention at these facilities could improve patient outcomes by not only increasing the use of AV fistulas, but also reducing catheter use and associated complications, including infections, hospitalization, and mortality.

 

In addition to identifying an opportunity for improvement at facilities falling below the DOQI target, we clearly have experts within our community whose experience we can draw upon to increase utilization of this preferred mode of access. Our project draws upon those experts to share their best and effective practices in designing and applying successful intervention strategies. The Network is sponsoring four regional workshops targeted to nephrologists, vascular access surgeons, interventional radiologists and vascular access managers affiliated with our intervention facilities (those with <40% HD patients utilizing AVFs.)Program faculty include:

 

·   Vo Nguyen, MD, a nephrologist practicing in Olympia, Washington, will discuss his successful AVF experience utilizing vein mapping by physical examination and Doppler Duplex scanning, long-range vascular access planning, establishing and maintaining good relationships with a VA team and conversion of AV grafts to AVFs.

·   Chris Griffith, MD, a vascular access surgeon who works with Dr. Nguyen, will discuss transposition AVF surgery and Doppler Duplex scanning interpretation as well the advantages to the surgeon of aggressive use of AVFs and the potential for conversion of functioning AV grafts to AVFs.

·   Carolyn Barclay, RN, CNN, Optimal Renal Care Vascular Access Coordinator will discuss the role of the Vascular Access Manager and the tools she uses in that role.

·   Steve Alford, a nurse educator with Medisystems will review the fine techniques used in cannulation and management of AVF access, including the buttonhole technique.

Page modified 5/13/2002