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Nephrol Dial Transplant (1999) 14: 2116-2118
© 1999 European Renal Association-European Dialysis and Transplant Association

Dialysis and Transplantation News

Management of vascular access for dialysis: an Italian survey

Decenzio Bonucchi, Alessandro D'Amelio, Gianni Capelli and Alberto Albertazzi

Division of Nephrology, Dialysis and Transplantation, University Hospital Modena, Modena, Italy

Correspondence and offprint requests to: Decenzio Bonucchi MD, Division of Nephrology, Dialysis and Transplantation, University Hospital, Modena, Via del Pozzo, 71, I-41100 Modena, Italy.

Abstract

Background. To obtain information on the management of vascular access in Italy.

Method. Questionnaire sent to all dialysis centres. The main questions were: (i) who is in charge of establishing vascular access? (ii) How is vascular access monitored? (iii) To what extent is a continuous quality programme implemented? (iv) What proportion of patients are treated using central venous catheters at the start of dialysis? (v) What proportion of patients are treated using central venous catheters as a permanent access? (vi) What is the role of interventional radiology?

Results. The response rate was 45%. All Italian regions were represented. In almost 80% of the dialysis centres vascular access is established by the nephrologist. Fistula function is monitored by most nephrologists using a recirculation test, ultrasound and radiological imaging. An audit (continuous quality programme) is implemented in 20% of the dialysis centres. A high proportion of patients are submitted for dialysis without an internal AV fistula (in one quarter of the centres more than 40% of the patients). Less than 10% of the patients are dialysed using central venous catheters as a permanent access. Interventional radiology for vascular access is used only in few centres.

Comments. Because of the difficulty of coordinating different professionals, most nephrologists manage vascular access by themselves. Fistula function is usually monitored on a routine basis, but a `Continuous Quality Programme' on established standards and audit of outcome and process indicators is not followed in most centres. Late referral is a main obstacle to effective planning of renal care, as indicated by the high frequency of temporary access at the beginning of dialysis. On the whole, vascular access is properly managed by Italian nephrologists, but monitoring performance by audit would be desirable.

Keywords: central venous catheters; interventional radiology; management; quality; vascular access


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