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.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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