A 10-Year Review of a Vascular Access Service for Patients Receiving Hemodialysis: Analysis of Procedural Modifications and Service Innovations

2016 ◽  
Vol 21 (2) ◽  
pp. 93-102
Author(s):  
John F. Lancashire ◽  
Michael Steele ◽  
Amy Swinbank ◽  
Dianne Du Toit ◽  
Mark J. Jackson
Keyword(s):  
Bloodstream Infection ◽  
Patient Outcomes ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Demographic Characteristics ◽  
Service Performance ◽  
Gold Coast ◽  
Infection Rates ◽  
Access Service ◽  
Arteriovenous Access

Abstract Objective: We aimed to identify trends in vascular access modalities for renal hemodialysis and to evaluate the influence of service modifications on service performance and patient outcomes. Methods: Retrospective analysis of incident and prevalent hemodialysis patients treated by the Gold Coast Hospital and Health Service, Queensland, Australia, between January 2004 and December 2013 was conducted. A comparison of patient demographic characteristics and analysis of trends in access modality and outcomes was performed for each group over the study period. Modifications to service structure and practice changes were also evaluated. Results: A total of 1787 patients (456 incident and 1331 prevalent) and 1671 procedures were examined. The proportion of patients starting hemodialysis on a catheter decreased from 79.2% to 63.6%. Patients starting hemodialysis on a fistula increased from 16.7% to a peak of 61.5% but fell to 27.3% in 2003. Catheter use in prevalent patients decreased from 11.7% to 6.1%, whilst fistula use increased from 60.6% to 88.5%. Graft access remained low for the incident group (0.0%–9.1%) and was reduced in prevalent patients from 27.7% to 4.9%. Bloodstream infection rates were reduced from 1.88 to 1.60 per 1000 dwelling-days. Endovascular and surgical revision of arteriovenous access was increased. Conclusions: Coordinated and multidisciplinary access service provided earlier referral for planned incident access with fewer catheters and increased fistulas with reduced bloodstream infection rates. Modifications to this vascular access service are associated with improved permanent access rates for incident and prevalent patients. There was an overall improvement of service performance and patient outcomes.

scholarly journals The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study

2020 ◽  
pp. 112972982093748
Author(s):  
Jia Shi ◽  
Jian-Jun Yan ◽  
Jian Chen ◽  
Qing-Hong Zhang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Epidemic Disease ◽  
Cross Sectional ◽  
Flow Reduction ◽  
Arteriovenous Access ◽  
Access Complications

Background: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. Methods: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. Results: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. Conclusion: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.

scholarly journals The association of genotype polymorphisms with vascular access patency in hemodialysis patients

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 24-30
Author(s):  
Chun-Fan Chen ◽  
Chih-Ching Lin
Keyword(s):  
Growth Factor ◽  
Vascular Access ◽  
Transforming Growth Factor ◽  
Coagulation Factors ◽  
Transforming Growth Factor Β1 ◽  
Hemodialysis Patients ◽  
Coagulation Cascade ◽  
Heme Oxygenase 1 ◽  
Methyl Transferase ◽  
Arteriovenous Access

Some hemodialysis patients suffer from repeat dysfunction of dialysis vascular access and need procedures of angioplasty, thrombectomy, and even temporary catheter use. Why these patients are vulnerable to vascular access dysfunction and how to improve its patency are imperative to be discovered. Traditional risk factors for vascular access function had been widely investigated but could not fully explain this question. Several genotype polymorphisms were demonstrated to increase the incidence of cardiovascular disease and might also be linked to higher risk of vascular access dysfunction. As the major causes of arteriovenous access thrombosis are hypercoagulable status and arteriovenous access stenosis, the investigated genes mainly focus on the mediators of the coagulation cascade, inflammatory process, and endothelial dysfunction. The reported polymorphisms of genes significantly associated with arteriovenous access dysfunction included genes encoding methylene tetrahydrofolate reductase, coagulation factors, heme oxygenase-1, matrix metalloproteinase, transforming growth factor-β1, tumor necrosis factor-α, vascular endothelial growth factor-A, renin-angiotensin-aldosterone system, and protein methyl transferase. However, further prospective study is indispensable to elucidate the association between the genotype polymorphisms and the outcome of vascular access. More and more therapeutic options that focus on genotype polymorphisms may generate a great benefit to the patency of vascular access of uremic patients.

Comparison of ethanol lock and heparin lock solution as prevention of catheter-related bloodstream infection in hemodialysis patients: systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 1 (1) ◽  
pp. 8-15
Author(s):  
Amy Rosalie ◽  
Made Angga Putra ◽  
Muhammad Rizki Bachtiar ◽  
David Hermawan Christian ◽  
Ivan Joalsen
Keyword(s):  
Randomized Controlled Trials ◽  
Bloodstream Infection ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Catheter Dysfunction ◽  
Ethanol Lock ◽  
Heparin Lock ◽  
Catheter Related Bloodstream Infection

Introduction: Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality. Preventive measures, including antibiotic lock, are inadequate due to the risk of resistance and insufficient effect against bacterial biofilm. Ethanol, an antimicrobial substance, is a potential prophylactic lock-in preventing CRBSI. This study aims to assess ethanol lock's effectiveness in preventing CRBSI in hemodialysis patients with a catheter as vascular access and its impact on catheter dysfunction. Methods: Researchers systematically searched online databases including Pubmed, Cochrane Library, and Science Direct for relevant randomized controlled trials (RCTs) published within 2011 until 2020. Relevant data were pooled in PICOs (Population, Intervention, Control, Outcomes) format and analyzed with Review Manager (version 5.3.5, Cochrane Collaboration, Denmark). Results: Seven RCTs involving 453 patients were assessed. The primary outcome indicates that prophylactic ethanol lock significantly reduces the incidence of CRBSI compared to that of heparin lock (RR=0.32, 95% CI 0.12-0.83, p=0.02, heterogeneity I2=68%). The secondary outcome suggests no significant difference in the incidence of catheter dysfunction in ethanol lock and heparin lock (RR=0.75, 95% CI 0.23-2.40, p=0.63, heterogeneity I2=68%). Conclusion: Ethanol is a potential prophylactic lock agent in preventing CRBSI in hemodialysis patients with catheter access. Further research is needed to synchronize the procedural use of ethanol lock and evaluate its long-term effect.

Prospective Surveillance for Primary Bloodstream Infections Occurring in Canadian Hemodialysis Units

2002 ◽  
Vol 23 (12) ◽  
pp. 716-720 ◽  
Author(s):  
Geoffrey Taylor ◽  
Denise Gravel ◽  
Lynn Johnston ◽  
John Embil ◽  
Donna Holton ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Significant Variation ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Surveillance Program ◽  
Infection Rates ◽  
Prospective Surveillance ◽  
Infection Surveillance

Objective:Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.Methods:Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period. Bloodstream infections were defined by published criteria. Hemodialysis denominators included the number of dialysis procedures, the number of patient-days on dialysis, and the frequencies of different types of vascular access.Results:There were 184 bloodstream infections in 133,158 dialysis procedures (1.4 per 1,000) and 316,953 patient-days (0.6 per 1,000). Hemodialysis access through arteriovenous (AV) fistulae was associated with the lowest risk for bloodstream infection (0.2 per 1,000 dialysis procedures). The relative risk for infection was 2.5 with AV graft access, 15.5 with cuffed and tunneled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access (P < .001). There was marked variation among the 11 centers in the means of vascular access used for hemodialysis. Significant variation in infection rates was observed among the centers when controlling for types of access.Conclusions:There was a hierarchy of risk of hemodialysis-related bloodstream infection according to type of vascular access. There was significant variation in the type of vascular access being used among the Canadian hemodialysis centers, and also variation in access-specific infection rates between centers.

scholarly journals Vascular Access and Risk of Bloodstream Infection Among Older Incident Hemodialysis Patients

2020 ◽  
Vol 2 (3) ◽  
pp. 276-285 ◽  
Author(s):  
Sophia V. Kazakova ◽  
James Baggs ◽  
Ibironke W. Apata ◽  
Sarah H. Yi ◽  
John A. Jernigan ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Hemodialysis Patients

scholarly journals Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

2021 ◽  
pp. 112972982096506
Author(s):  
Eva Chytilova ◽  
Tamara Jemcov ◽  
Jan Malik ◽  
Jernej Pajek ◽  
Branko Fila ◽  
...  
Keyword(s):  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Preoperative Mapping ◽  
High Incidence ◽  
Arteriovenous Access ◽  
Ultrasound Parameters ◽  
Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

scholarly journals Adapting a vascular access service (VAS) to meet the needs of the COVID-19 pandemic

2021 ◽  
Author(s):  
Ziya Zhang ◽  
Celia Wells ◽  
Amy Brito ◽  
Christy C. Chan ◽  
Gopi Patel ◽  
...  
Keyword(s):  
Vascular Access ◽  
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