title: Comparison of treatment delay associated with tunneled hemodialysis catheter placement between interventionists.
abstract: OBJECTIVE
  Fragmented care in nephrology can cause treatment delays. Nephrologists are qualified to perform vascular access-related procedures because they understand the pathophysiology of renal disease and perform physical examination for vascular access. We compared treatment delays associated with tunneled hemodialysis catheter (TDC) placement between interventional radiologists and nephrologists.
  
  
  METHODS
  We collected data by radiologists from January 1, 2011 through December 31, 2011 and by nephrologists from since July 1, 2012 through June 30, 2013. We compared the duration from the hemodialysis decision to TDC placement (D-P duration) and hemodialysis initiation (D-H duration), catheter success and the complication rate, and the frequency and the usage time of non-tunneled hemodialysis catheters (NDCs) before TDC placement.
  
  
  RESULTS
  The study analyzed 483 placed TDCs: 280 TDCs placed by radiologists and 203 by nephrologists. The D-P durations were 319 minutes (interquartile range [IQR], 180 to 1,057) in the radiologist group and 140 minutes (IQR, 0 to 792) in the nephrologist group. Additionally, the D-H durations were 415 minutes (IQR,260 to 1,091) and 275 minutes (IQR, 123 to 598), respectively. These differences were statistically significant (p = 0.00). The TDC success rate (95.3% vs. 94.5%, respectively; p = 0.32) and complication rate (16.2% vs. 11%, respectively; p = 0.11) did not differ between the groups. The frequency (24.5 vs. 26%, respectively; p = 0.72) and the usage time of NDC (8,451 vs. 8,416 minutes, respectively; p = 0.91) before TDC placement were not statistically significant.
  
  
  CONCLUSIONS
  Trained interventional nephrologists could perform TDC placement safely, minimizing treatment delays.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Yoo Hyung
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Hae Ri
authors.initials: HR
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Hong Jae
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Ye-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Sa Ra
authors.initials: SR
authors.lastname: Jung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Dae Eun
authors.initials: DE
authors.lastname: Choi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Kang Wook
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Ki Ryang
authors.initials: KR
authors.lastname: Na
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002983:Clinical Competence; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists; D015642:Radiology, Interventional; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013038:Specialization; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Nephrology; Radiology; Renal dialysis; Vascular access devices