Skip Navigation

Vascular Access Quality Improvement Project

Final Catheter Reduction Project Report ESRD Network 11 March 31, 2003. Assessment and Reduction of Catheters in Hemodialysis.

Alicia Hare, Jan Deane, Diane Carlson, ESRD Network 11, St. Paul, MN, Bruce Lindgren, Biostatistics Consulting Lab, University of Minnesota, Minneapolis, MN.

Abstract

Background

K/DOQI Vascular Access Guideline #30 states that less than 10% of patients on hemodialysis should use a catheter for chronic dialysis (i.e., longer than three months). The 2001 CPM Project showed that in Network 11, 19% of patients were dialyzed with a catheter for three months or longer. This indicates a significant opportunity to reduce catheter use.

Goals

The goal of this project is to use two interventions in an effort to decrease catheter rates and to create system change within Network 11 dialysis facilities that will be sustainable following the completion of the project. Improvement was measured based on the Reduction in Failure Rate (RFR) in the three-month to six-month catheter rates between the comparison group (Jan-June 2001) and the intervention group (Jan-June 2002).

Methods

The project sample included all adult patients beginning in-center hemodialysis during Jan-June 2002. All catheter patients were identified at incidence and assessed at three months for catheter status. Patients who were still dialyzing with a catheter as sole access were identified for intervention. The intervention consisted of a protocol and model algorithm, developed by the Network 11 Medical Review Committee. The patients were then assessed at six months for catheter status. Patients who died, transferred to peritoneal dialysis (PD), or underwent transplantation within the first 3 months of treatment were excluded.

Results

The three-month to six-month catheter rates decreased significantly (p=0.011) from 52.7% in 2001 to 44.8% in 2002, and the RFR was 15%. The vascular access surgeon referral rates also improved significantly from 43.4% in 2001 to 51.3% in 2002 (p=0.01), and the RFR was 15%. In addition, 44.4% of facilities stated that the model protocol was useful in overcoming barriers to referral and placement of permanent access, 34.4% of facilities stated that practice changed as a result of the project, and 31.3% of facilities established a vascular access management procedure as a result of the project.

Conclusion

Project objectives were met. Further work and analyses are planned.

Read the Vascular Access Final Report (45 KB PDF file opens in new browser)

Get Adobe Acrobat Reader (Link to Adobe Web site opens in new window.)