Document Detail


Focused vascular access education to reduce the use of chronic tunneled hemodialysis catheters: results of a network quality improvement initiative.
MedLine Citation:
PMID:  20017841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tunneled hemodialysis catheters (TDCs) carry the highest mortality risk for chronic hemodialysis patients of any access modality. Recent data have emphasized that mortality risk decreases when these devices are discontinued. Herein, we present the results of a gap-reduction assisted catheter elimination strategy that Network 7 employed as its quality improvement initiative to reduce the use of TDCs. Hemodialysis facilities with high catheter rates (>90 days) were identified. Interventions included focused vascular access education, monthly follow-up and site visits to assist the facility catheter reduction program. The "goal" of interventions was defined as the gap-reduction of 50% from the baseline catheter rate to the Network mean plus sustainability of catheter reduction for at least 3 consecutive months. Fifteen facilities (n = 891) were identified with high catheter rates (31.5 +/- 5.3%) in May 2006. Interventions resulted in a catheter reduction to 12.2 +/- 8.5% in May 2007 (p = 0.0001). Five of the 15 facilities (n = 280) achieved the goal (preintervention = 31.7 +/- 5.3%, postintervention = 8.7 +/- 2.8%, p = 0.001). In May 2007, eight additional facilities (n = 438) with high catheter rates (31.7 +/- 7.8%) were added to the 10 that failed to achieve the goal previously. Interventions employed in these 18 facilities (n = 1,049) resulted in catheter reduction in all (preintervention = 31.5 +/- 5.5%, postintervention = 16.2 +/- 5%, p = 0.01). Five of these 18 met the goal (preintervention = 32 +/- 8%, postintervention = 5.9 +/- 4.3%). Overall, all 23 facilities (n = 1,329) demonstrated catheter reduction postintervention (preintervention = 31.6 +/- 6%, postintervention = 13.9 +/- 6%, p = 0.001), and 10/23 (43%) met the project goal (preintervention = 31.9 +/- 6%, postintervention = 7.3 +/- 4%, p = 0.002). Medical director's involvement had a positive impact in achieving the goal (p = 0.003). The presence or absence of a vascular access coordinator did not affect catheter reduction. The results of this analysis reveals that an organized approach implemented by an ESRD Network can have a significant impact in reducing catheter use.
Authors:
Deuzimar Kulawik; Jeffrey J Sands; Kelly Mayo; Mary Fenderson; Janet Hutchinson; Cindy Woodward; Sally Gore; Arif Asif
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Seminars in dialysis     Volume:  22     ISSN:  1525-139X     ISO Abbreviation:  Semin Dial     Publication Date:    2009 Nov-Dec
Date Detail:
Created Date:  2009-12-18     Completed Date:  2010-04-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  692-7     Citation Subset:  IM    
Affiliation:
The End Stage Renal Network of Florida, Florida, USA.
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MeSH Terms
Descriptor/Qualifier:
Catheters, Indwelling / adverse effects,  utilization*
Humans
Inservice Training*
Logistic Models
Quality Assurance, Health Care*
Renal Dialysis / instrumentation*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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