CathAway fistula vascular access program achieves improved outcomes and sets a new standard of treatment for end‐stage renal disease

Abstract

Hemodialysis patients using central venous catheters (CVCs) for vascular access are at greater risk of infection and death vs. arterial venous fistula (AVF). In 2008, DaVita initiated the CathAway quality improvement initiative, a multidisciplinary program to reduce CVC use in favor of AVF. Our retrospective analysis examined CVC use for incident (≤90 days) and prevalent (>90 days) patients receiving hemodialysis in the years 2006 to 2010. Outcomes included annual mean percentage of patients with CVCs, new CVC placements per 100 patient years, CVC survival, and percentage patient days with CVC. Over 152,000 patient records were reviewed. Between 76.2% and 79.7% of incident patients used a CVC annually, but for prevalent patients, the proportion decreased from 41.1% in 2006 to 33.5% in 2010. The number of new CVC placements per 100 patient years increased slightly for incident patients but fell annually from 64.8 in 2006 to 55.2 in 2010 for prevalent patients. The percentage of treatment days with CVCs was stable among incident patients (70.4%-74.3%) but fell among prevalent patients from 26.1% in 2006 to 16.5% in 2010. The mean duration of CVC use in incident patients was between 53.0 days (SD, 27.8) in 2006 and 54.1 days (SD, 28.1) in 2009, and for prevalent patients between 158.9 days (SD, 123.0) in 2006 and 128.1 days (SD, 112.0) in 2010. CathAway significantly decreased CVC use in prevalent hemodialysis patients. Decreasing incident patient use will require improvements in predialysis care.

Confounders of mortality and hospitalization rate calculations for profit and nonprofit dialysis facilities: analytic augmentation

“…Moreover, considering that facility census is the chief economic driver, any sacrifice in quality that leads to missed treatments (eg, due to hospitalization), death, or transfer of care away from the provider organization are economically counter-productive. Furthermore, profit motives may spur clinical innovations such CathAway [24], Incident Management of Patients, Actions Centered on Treatment (IMPACT) [25], and RightStart [26], which positively affect outcomes for hemodialysis patients. The integration of ESRD patient care with other aspects of healthcare have also been facilitated by the FP LDOs including surgical centers for vascular access and endovascular care (LifeLine, Ultracare), specialty pharmacies for dialysis patients (DaVita Rx [27], Fresenius Rx) and patient-focused programs for diabetes disease management (Village Health StepAhead).…”

Risk Factors for Infection-Related Hospitalization in In-Center Hemodialysis

“…Increasing attention has been focused on infection prevention and control as exemplified by a number of initiatives and changes in policy, including the CDC's NHSN dialysis event reporting system, the CDC's Dialysis Bloodstream Infection Collaborative (21), select ESRD network initiatives, large dialysis organization quality initiatives targeting reduction of dialysis catheters or bloodstream infections (17,18), and the expanded and defined role of dialysis facility medical directors in infection prevention and control (22,23). The CDC has developed core interventions for dialysis facilities to prevent bloodstream infections among patients on dialysis (24).…”

Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients

“…5,6 However, a number of concerns have been raised regarding heparin use: dosing errors or overfilling of the catheter lumen can result in systemic anticoagulation and heparin-induced thrombocytopenia, and heparin has also been shown to promote Staphylococcus aureus biofilm formation in vitro. 7,8 Recent initiatives to reduce rates of CVC use in HD patients have had some success, 9,10 although rates remain unacceptably high. 1 A variety of factors contribute to the high rates of CVC use in HD patients, including lack of predialysis care, maturation failure for arteriovenous fistulas and grafts, patient resistance to permanent access placement, and fistula stenosis and thrombosis.…”