Dr Paul Nguyen1, RN IMELDA DE GUZMAN1, DR JEFFREY WONG1, DR TIM SPICER1,2, DR RENUKA SHANMUGALINGAM1,2,3, PROFESSOR ANGELA MAKRIS1,2,3
1Department of Nephrology, South Western Sydney Local Health District, Sydney , Australia, 2University of New South Wales, Sydney, Australia, 3University of Western Sydney, Sydney, Australia
Aim: To assess the effectiveness of an implemented international guidelines based protocol for the management of haemodialysis patients presenting with thrombosed arterio-venous fistulas and grafts.
Background: Arteriovenous fistulas and grafts (AVF/Gs) are important forms of vascular access for patients requiring haemodialysis, but are prone to patency complications such as stenosis and thrombosis. This may adversely impact dialysis quality and patient morbidity and mortality.
Methods: A before and after retrospective observational cohort study was conducted of all incident haemodialysis patients presenting with thrombosed/stenosed AVF/Gs to Liverpool Hospital. Patients presenting 12 months before (2020) and 12 months after (2021) the protocol was implemented were included. Patients were assessed against key performance indicators (KPI) set as per guideline recommendations. Data were analysed with SPSS, and there was no blinding; all parties were engaged with change in practice prior to implementation.
Results: There were a total of 40 incidents of blocked access in 2020, and 59 in 2021. Comparison of data pre and post implementation of the protocol showed no difference in time to percutaneous intervention within 24 hours (32% vs 45%, P = 0.3), percentage of AVF/Gs with no attempt at de-clotting (38% vs. 31%, P = 0.7) and length of stay (3 days [IQR 2 – 10.5] vs. 3 days [IQR 1 – 8], P = 0.3). Initially there was a difference in the rate of vascath insertion (55% vs. 23%, P = 0.02), but not after adjustment of group differences (P = 0.6).
Conclusion: The implemented protocol did not result in improvements in outcomes for hemodialysis patients presenting with blocked AVF/Gs. Further review of current practices, plan-do-study-act cycles and a quality-audit-reporting-system are needed by relevant stakeholders.
Biography:
bio to come