Vascular Access
As the "lifeline" of the patient on hemodialysis, vascular access should be a primary focus of quality improvement activities. While efforts are underway to improve vascular access outcomes by increasing the use of AV fistulas (see Fistula First), the majority of patients in Network 8 continue to dialyze with AV grafts or central venous catheters. Dialysis facility staff and other vascular access team members must work together to:
- Establish the most appropriate vascular access for each patient
- Maintain the access once established
- Minimize the risks associated with each vascular access type
- Preserve future sites for vascular access
These goals may be accomplished through better communication, education, vascular access monitoring, early referral for intervention, and utilization of proper procedures.
CMS and the ESRD Networks currently collect data and monitor the following vascular access clinical performance measures:
- Maximizing placement of AV fistulae – AVFs have better patency rates, once established, requiring fewer interventions and are associated with decreased costs, complications, risks of morbidity and mortality. Click here to see NW 8 performance. (link pops open in a new window)
- Minimizing use of catheters as chronic dialysis access – Catheters are associated with complications such as: low blood flow rates resulting in inadequate dialysis, systemic and local infections, central venous stenosis, increased morbidity and mortality. Click here to see NW 8 performance. (link pops open in a new window)
- Monitoring AV grafts for stenosis – The K/DOQI Guidelines recommend weekly physical exam of vascular access plus periodic surveillance (by means of tests) for stenosis, in order to correct and improve patency and decrease the incidence of thrombosis. Click here to see NW 8 performance. (link pops open in a new window)
Tools and Resources
- Stenosis Monitoring Methods (348 KB PDF file opens in new browser)
- Checklist of Indications for Hemodialysis Catheter Use (21 KB PDF file opens in new browser)
- Management of Patients with CVC (15 KB PDF file opens in new browser)
- Reducing CVC Infections (13 KB PDF file opens in new browser)
- "How is your facility monitoring venous stenosis?" (Network 8 would like to thank Network 16 for this helpful chart)
- NW 8 MRB Recommended Methods of Stenosis Monitoring (20 KB PDF file opens in new browser)
- Staff Resources (26 KB PDF file opens in new browser)
