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NDT Advance Access published online on March 29, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm076
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Implementation of a vascular access quality programme improves vascular access care

M. van Loon1, W. van der Mark2, N. Beukers3, C. de Bruin3, P. J. Blankestijn2, R. M. Huisman3, J. J. Zijlstra4, F. M. van der Sande1 and J. H. M. Tordoir1

1Department of Surgery and Nephrology, University Hospital Maastricht, 2Department of Nephrology, University Medical Center Utrecht, 3University, Hospital Groningen, Department of Radiology and 4Hospital Midden-Twente Hengelo, The Netherlands

Correspondence and offprint requests to: J. H. M. Tordoir, MD, PhD, Vascular surgeon, Department of Surgery, University Hospital Maastricht, P. Debeijelaan 25, PO Box 5800, 6202AZ Maastricht, The Netherlands. Email: j.tordoir{at}surgery.azm.nl



  Abstract

Introduction. In the Netherlands an access quality improvement plan (QIP) was introduced by vascular access coordinators (VAC) with the aim to decrease vascular access-related complications by preemptive intervention of malfunctioning accesses. A vascular access QIP was established in 24 centres (46% of all Dutch facilities) and a structural multidisciplinary vascular access meeting was instituted.

In these centres, including 2300 patients, a protocol for enhancement of fistula creation and access surveillance programme was implemented, with instruction of physicians and nurses, and rounds to discuss complications and evaluate vascular access interventions. The number and type of vascular access, permanent catheters, thrombosis rates and number of interventions were evaluated at the start and end of the study period.

Results. After the surveillance programme, the number of autogenous arterio-venous fistulas (AVFs) had increased significantly from 69 to 77% (P < 0.01), while the use of temporary subclavian vein catheters declined (34% vs 11%) (P < 0.01), with a substantially higher percentage of jugular vein catheters (from 23 to 35%). Interventional treatment of malfunctioning accesses by percutaneous transluminal angioplasty (PTA) (from 0.39 to 0.50 patient/year; P < 0.001)) and surgical revisions (from 0.06 to 0.12 per patient/year; P < 0.001) also increased.

Conclusion. These data demonstrate that a vascular access QIP resulted in placement of more autogenous AVFs, increased number of PTAs and surgical interventions. These findings suggest that a vascular access care QIP is worthwhile to improve dialysis patients’ care and access morbidity.

Keywords: arteriovenous fistula; preemptive intervention; surveillance; vascular access

Received for publication: 1. 1.07
Accepted in revised form: 26. 1.07


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