title: Effect of a rapid clinical protocol to the conversion from central venous hemodialysis catheter to arteriovenous access.
abstract: OBJECTIVE
  Evaluation of the rapid conversion protocol that includes an ambulatory dialysis access center (DAC), and a three-step clinical pathway, to the conversion rate from central venous hemodialysis (HD) catheter to functioning arteriovenous (AV) access.
  
  
  METHODS
  Prospective data were collected on 97 consecutive catheter-dependent HD patients. DAC is defined as an ambulatory unit, able to accommodate clinic visits, ultrasound examinations, surgical, interventional and hybrid procedures. Step I: initial evaluation, vein mapping and creation of AV access. Step II: clinical evaluation in two weeks and if failure identified, secondary procedure to restore function. Step III: evaluation in four weeks after creation, and additional procedure to promote maturation if indicated. The success rate, time to conversion and time to catheter removal were recorded.
  
  
  RESULTS
  From the 97 consecutive referred patients, eight patients were excluded. From the remaining 89 patients, 99% were successfully converted to AV access. Seventy-three percent of the patients were converted to native arteriovenous fistulae and 27% of the patients to prosthetic arteriovenous shunts. The median time from creation to HD catheter removal was 63 (SD 41) days. Fifty-two percent of the patients required at least one additional secondary procedure to accomplish successful conversion.
  
  
  CONCLUSIONS
  High rates of timely conversion from catheter to AV access, primarily AV fistulae, can be accomplished within the context of the rapid conversion protocol.
authors.affiliation: Dialysis Access Center, Buffalo Mercy Hospital, Buffalo, New York - USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Blessios
authors.affiliation: Dialysis Access Center, Buffalo Mercy Hospital, Buffalo, New York - USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Park
authors.affiliation: Dialysis Access Center, Buffalo Mercy Hospital, Buffalo, New York - USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Barone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous / Q000295:instrumentation; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002985:Clinical Protocols; D019091:Critical Pathways; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014654:Vascular Patency