Vascular Access Improvement Initiatives

- A Team Approach

Presented by Ms Leung Lai Man

Renal Unit / PMH

Princess Margaret Hospital (PMH)

Renal Unit of PMH

A major dialysis and renal transplant center in KWC

cluster

Dialysis service started in 1977

A pioneer NHHD training center

Haemodialysis

Renal Replacement Therapy

Vascular Access

Basic requirement for HD treatment

“Life-line” for HD patients

Types:

Arteriovenous Fistula (AVF)

Arteriovenous Graft (AVG)

Central Venous Catheter (CVC)

Cuffed or non-cuffed

Kidney Disease Outcomes and Quality Initiative

(KDOQI) recommendations (NKF 2002):

AVF provides better outcomes than AVG or CVC

Prevalence of AVF use for HD > 65%

Cuffed catheter for permanent dialysis access <10% of

HD patients

National Vascular Access Improvement Initiative

Fistula First Breakthrough Initiative (FFBI)

Recommend to use AVF

of Vascular Access for HD

Aim

To promote use of arteriovenous fistula (AVF)

and to improve functionality and outcomes of

vascular access through a multidisciplinary team

approach

Objectives

To initiate the Fistula First movement

and promote use of AVF for HD

To improve and maintain functionality of vascular

access through:

early access referral, creation, timely trouble shooting and

complication management;

effective staff training;

patient education

To improve vascular access outcomes by

empowering patients regarding self-care on

vascular access and complication management.

Background Data: Type of Vascular Access (As at 31.12.2010)

Functional AVF placement

rate > 65% of patients

Cuffed catheter for permanent

dialysis access <10% of

patients

Background Data: Vascular Access Outcomes

*Primary non-function: defined as the inability to use the AVF/AVG at 30 days

(KDOQI guidelines)

# Early complications :e.g. Bleeding , haematoma, infection, non-infectious

fluid collection etc…

Team Approach

Meeting with Multi-disciplinary Vascular Access

Team:

Nephrologists

Surgeons

Renal Nurses

Radiologists

Review of Workflow

Initiatives

Initiatives

Initiatives

Formulation of New Workflow

↑ FU assessment

and

↑communication

between medical

& surgical team

Formulation of New Workflow

↑ post-op monitoring

and early referral for

problem / failed

AVF

Patient Education Material

AVF Care Teaching Manual

血管造瘻護理手冊

Staff Training

Lectures

Assessment Skill

Cannulation Skill

Outcomes

Types of Vascular Access

2010

2011

AVF Functionality

*Primary non-function:defined as the inability to use the AVF/AVG at 30 days

(KDOQI guidelines)

# Early complications: e.g. Bleeding , haematoma, infection, non-infectious fluid

collection etc

Conclusion

Prevalence of AVF creation and functional AVF use

increased.

Early complications after AVF creation well controlled

with early referral for interventions.

A multidisciplinary team approach is critical to booster

AVF use and to achieve successful vascular outcomes.

Acknowledgement Renal Team Surgical Team Dr. Tong Kwok Lung Dr. Yiu Ming Kwong

Dr. Fung Ka Shun Dr. To Kim Chung

Dr. Tang Hon Lok Dr. Ma Wai Kit

Renal NC Ms. Irene Kong

WM Ms Sharon Wong

APN Ms Lee S H

All Medical &

Nursing

Staff