WHEN IS FISTULA FIRST A SECOND RATE OPTION FOR LONG TERM DIALYSIS ACCESS
Dr Neesan David1, Dr Stephen May1
1Tamworth Rural Referral Hospital, Tamworth, Australia
Aim: After a recent patient had a below knee amputation following ischaemia related to a polytetrafluoroethylene loop, we reviewed the outcomes of long-term tunnelled dialysis catheters from the New England renal service.
Background: Catheter complication rates include catheter-related blood stream infections (CRBSI) and malfunction. A large recent trial in Australia has shown CRBSI occur between 0.21-0.29 per 1000-CDs (CDs).
Methods: A retrospective audit was conducted analysing prevalent patients with long-term tunnelled haemodialysis catheters, defined as those in situ for greater than 6 months despite multiple fistula attempts. The parameters analysed were the rate of CRBSI, catheter revisions and number of failed fistula surgeries. Patients were subdivided into two groups. Long term dialysis access pathway by catheter only (group 1) or catheter while awaiting further fistula attempts (group 2).
Results: 16 patients met inclusion criteria. There were 9 patients in group 1 and 7 in group 2. The combined rate of CRBSI was 0.18 per-1000 CDs (group 1: 0.16, group 2: 0.22). The combined rate of catheter replacement was 2.30 per-1000 CDs (group 1: 2.56, group 2: 1.94). The combined rate of fistula revisions was 5.51 per-1000 CDs (group 1: 5.60, group 2: 5.40). The combined fistula creation attempts was 2.48 per-1000 CDs (group1: 2.72, group 2: 2.16).
Outcomes: Group 1 had an average of 8 fistula procedures prior starting a long-term catheter pathway and subsequently had low rates of CRBSI and catheter interventions.
Conclusion: Fistulas are associated with multiple procedures and morbidity. In units with low CRBSIs, catheters may be better suited for selected patients. Selection and outcome criteria for catheter first assignment needs to be developed and used for quality indicators.
Biography:
First year nephrology advanced trainee within the East Coast New England Renal Network.