VASCULAR ACCESS IN PATIENTS COMMENCING HAEMODIALYSIS – RESULTS OF IMPLEMENTATION OF A QUALITY IMPROVEMENT PROJECT

T YOUNG1 , M MANNING1, L PHIPPS1, K FOGO1

1Orange Health Service, NSW Australia

Aim: To review a QI project regarding initial access in patient commencing haemodialysis

Background: An arteriovenous fistula (AVF) is the preferred initial access in patients new to haemodialysis (1). For patients residing in our rural area, access to specialist vascular surgeon input , and distance to both our facility and tertiary facilities pose challenges in implementing best practice.

Method: An initial audit of access in patients commencing dialysis demonstrated high rates of central venous catheter (CVC) and arteriovenous graft (AVG) use . In the year preceding the intervention, initial access was via AVF in 2/15 cases, AVG in 1/15 cases and CVC in 12/15 cases.

A multifaceted, preemeptive approach was developed, utilising an skilled ultrasonographer, and patient education regarding access preservation . A vascular surgeon was recruited to visit our site on a monthly basis.

Results: In the three years following this intervention, the proportion of patients commencing access improved, with 7/8 patients commencing with a pre formed AVF, and only 1/8 with a CVC, in the preceeding year.

Conclusion: Our quality improvement project demonstrated an increased in adherence to a gold standard for initial access. Further analysis is required to review clinical characteristics of these patients and review any impact on cost benefit to our organisation.

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