Unraveling the realities of vascular access: the Network 11 experience.
Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.
Besarab
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Renal Network of the Upper Midwest, Inc, ESRD Network 11, St. Paul, MN 55114, USA.
Adams
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M
Amatucci
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S
Bowe
D
D
Deane
J
J
Ketchen
K
K
Reynolds
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K
Tello
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D002675:Child, Preschool; D005260:Female; D013502:General Surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D012017:Referral and Consultation; D006435:Renal Dialysis; D017749:Total Quality Management; D014481:United States