title: The use of vascular access audit and infections in home hemodialysis.
abstract: Vascular access-related infection is an important adverse event in home hemodialysis (HHD). We hypothesize that errors in self-cannulation or manipulation of dialysis vascular access are associated with increased incidence of access-related infection. We conducted a retrospective cohort study of all prevalent HHD patients at the University Health Network. All vascular access-related infections were recorded from 2006 to 2013. Errors in dialysis access were ascertained by nurse-administered vascular access checklist. Ninety-two patients had completed at least one vascular access audit. Median HHD vintage was 2.3 (0.9-5.0) years in patients with appropriate vascular access technique and 5.8 (1.5-9.4) years in patients with erroneous vascular access technique. The overall rate of infection between patients with and without appropriate vascular access technique was similar (0.27 and 0.28 infections per year, P = 0.166). Among patients who were identified with errors in dialysis access manipulation, patients with five or more errors were associated with higher rate of access-related infection (mean of 0.47 vs. 0.16 infection per patient-year, P < 0.001). The use of vascular access audit is a feasible strategy, which can identify errors in vascular access technique. Patients with a longer median HHD vintage are associated with higher risk of inappropriate vascular access technique. Patients with multiple errors in vascular access technique are associated with a higher risk of dialysis access-related infection. Prospective evaluation of the impact of vascular access audit on adverse vascular access events is warranted.
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rousseau-Gagnon
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Faratro
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Celine
authors.initials: C
authors.lastname: D'Gama
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Stella
authors.initials: S
authors.lastname: Fung
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wong
authors.affiliation: Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003133:Commission on Professional and Hospital Activities; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D014654:Vascular Patency / Q000502:physiology*
keywords: Vascular access; catheter; fistula; hemodialysis; home hemodialysis; infection