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John F. Lancashire, BSc (Hons), MBBS, PhD

Adjunct Clinical Research Fellow, Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia, Victoria, Australia

Dr. John Lancashire is a Hospital Medical Officer in vascular and general surgery at the Royal Melbourne Hospital, Victoria, Australia. His previous appointments include vascular and general surgery and intensive care medicine at the Gold Coast and Robina Hospitals, Queensland, Australia. He is an Adjunct Clinical Research Fellow at the Institute for Glycomics, Griffith University, Australia with research interests in surgery, vaccine technologies and bacterial pathogenesis. Dr. Lancashire has held post-doctoral research appointments in molecular microbiology at The University of Queensland, Australia, and Imperial College London.

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Advancing Vascular Access Track

H103 – Oral Abstract Presentations (H103)

A 10-year Review of a Vascular Access Service for Renal Dialysis Patients: An Analysis of Procedural Modifications and Service Innovations

calendar9/9/2014

clock1:30 PM - 1:45 PM

clockRoom: Potomac 5-6

CE Hours: 1.2 per four (4) 15-minute sessions


John F. Lancashire, BSc (Hons), MBBS, PhD

Adjunct Clinical Research Fellow, Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia, Victoria, Australia

Background: Within the last 10 years our service has undertaken changes to improve compliance with the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. Purpose: Retrospective analysis of annual incident and prevalent dialysis patients from 2004 to 2013 to identify trends in access modalities and to evaluate the impact of service modifications on patient outcomes and service performance. Project: All incident haemodialysis and peritoneal dialysis and prevalent haemodialysis patients treated by this vascular access service between January 2004 and December 2013 were examined. A comparison of patient demographics and analysis of trends in access modality and outcomes was performed for each group over the study period. Modifications to service structure and practice changes were evaluated. Results: A total of 1787 patients (456 incident and 1331 prevalent) and 1671 procedures were examined. Incident catheter access decreased from 59% to 44%, and from 12% to 6% in prevalent patients. Incident fistula access increased from 13% up to 47% during the study period, however decreased to 19% in 2013. Prevalent fistula access increased from 61% to 89%. Graft access remained low for the incident group (0% to 6%) and was reduced in prevalent patients from 28% to 5%. Blood stream infection (BSI) rates were reduced from 6.9 to 1.3 per 1000 dwelling days. Endovascular and surgical revision of arteriovenous access was increased and AVG thrombectomy rates improved. Implications: Coordinated and multidisciplinary access service provided earlier referral for planned incident access with fewer catheters and increased fistulas with reduced BSI rates. Change in practice using fewer grafts and greater endovascular and surgical access revision with increased operating capacity. Conclusions: Modifications to this vascular access service are associated with improved permanent access rates for incident and prevalent patients. There is overall improvement of service performance and patient outcomes.

Learning Objectives:

  • Articulate how to optimise efficiency of vascular access services for renal dialysis patients.
  • Describe the changes to arteriovenous access for incident and prevalent dialysis.
  • Evaluate vascular access service modifications using performance indicators.

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