[Definition of processes and indicators for the management of vascular accesses for hemodialysis].
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.
Almonacid
Pedro Jiménez
PJ
Servicio de Cirugía General, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
Gruss
Enrique
E
Lorenzo
Susana
S
Lasala
Manuel
M
Hernández
Teresa
T
Portolés
José
J
Rueda
José Antonio
JA
Tato
Ana
A
Del Cerro
Julián
J
Quintans
Antonio
A
D002408:Catheters, Indwelling; D003663:Decision Trees; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*