title: [Definition of processes and indicators for the management of vascular accesses for hemodialysis].
abstract: BACKGROUND
  The prevalence of renal replacement therapy has increased, affecting 885 patients per million inhabitants. More than 50% of these patients require hemodialysis with permanent vascular access. In our center a multidisciplinary group was organized to manage processes related to vascular access for hemodialysis.
  
  
  OBJECTIVE
  To define processes for the management of vascular access for hemodialysis and to evaluate these processes.
  
  
  METHODS
  Setting. Level III hospital in the autonomous community of Madrid serving 485,000 inhabitants.
  
  
  METHODS
  2002-2004.
  
  
  METHODS
  A multidisciplinary working group was set up. The three most frequent processes were defined and described. Flow charts were used for graphical representation. Quality criteria and indicators were defined with prospective monitoring of electronic medical records, design of a specific surgical protocol, and retrospective analysis.
  
  
  RESULTS
  Comparison of the results with the literature. First vascular access. The percentage of patients with arteriovenous fistulas on starting hemodialysis. Percentage of prevalent patients with venous access (autologous fistula, prosthetic device, catheter). Maintenance of access: Rate of thrombosis in autologous-prosthetic arteriovenous fistulas. Percentage of rescued arteriovenous fistulas after thrombosis. Rate of temporary catheters. Resource management. Percentage of ambulatory interventions. Rate of admissions related to arteriovenous fistulas.
  
  
  CONCLUSIONS
  Arteriovenous fistulas are the main source of morbidity and hospital admission in patients with chronic renal failure in hemodialysis programs. Multidisciplinary management achieves results above the standards described in the literature. There do not appear to be other determining factors for these results, since the technical procedures performed do not differ from those described in the literature.
authors.affiliation: Servicio de Cirugía General, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
authors.forename: Pedro Jiménez
authors.initials: PJ
authors.lastname: Almonacid
authors.forename: Enrique
authors.initials: E
authors.lastname: Gruss
authors.forename: Susana
authors.initials: S
authors.lastname: Lorenzo
authors.forename: Manuel
authors.initials: M
authors.lastname: Lasala
authors.forename: Teresa
authors.initials: T
authors.lastname: Hernández
authors.forename: José
authors.initials: J
authors.lastname: Portolés
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Rueda
authors.forename: Ana
authors.initials: A
authors.lastname: Tato
authors.forename: Julián
authors.initials: J
authors.lastname: Del Cerro
authors.forename: Antonio
authors.initials: A
authors.lastname: Quintans
mesh_terms: D002408:Catheters, Indwelling; D003663:Decision Trees; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*