The impact of tunnelled vascular catheters on time to arteriovenous fistula creation.
OBJECTIVE
The purpose of this study is to examine the effect of the presence of tunnelled vascular catheter (TVC) on physician referral and surgeon review and operating patterns and ultimately time of creation of permanent haemodialysis (HD) access.


METHODS
A retrospective analysis of TVC and arteriovenous fistulae (AVF) databases in 2010. Physician referral time and surgical time to operation were compared between patients commencing HD with TVC and a control group who commenced HD with AVF.


RESULTS
The AVF group (n = 27) commenced HD with an AVF and TVC group (n = 49) commenced HD via a TVC. Time from physician referral to surgeon review in the AVF vs. TVC group was 29 vs. 35 days (p = 0.6). Time from surgeon review to access creation was 43 vs. 50 days (p = 0.4). However, in the TVC group, the time from TVC insertion to physician referral to a surgeon was an additional 109 ± 20 days. Subgroup analysis of 11 TVC patients (23%) presenting at end stage without AVF (crash starters) had a TVC to physician referral time of 103 ± 75 days, physician referral to surgeon review of 14.4 ± 4 days and surgeon review to AVF of 67 ± 23 days.


CONCLUSIONS
The presence of a TVC is associated with a significant delay (>3 months) before physicians make a referral for surgeon review. There was no surgeon-related delay to access creation related to the presence of a TVC.
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Hareeshan
H
Nandakoban
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Ananthakrishnapuram
A
Aravindan
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Tim
T
Spicer
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Govind
G
Narayanan
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Noemir
N
Gonzalez
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Michael
M
Suranyi
Renal Unit, Liverpool Hospital, Sydney, New South Wales - Australia.
Jeffrey K W
JK
Wong
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult