Initiative to reduce central venous catheter use in dialysis patients

RPA launches initiative to reduce central venous catheter use in dialysis patients
9/8/2010
  The Renal Physicians Association is collaborating with several renal providers and associations to develop a Vascular Access initiative (VAI) to reduce central venous catheter (CVC) use among hemodialysis patients.   

RPA says approximately 82% of patients with end-stage renal disease start dialysis with a CVC, and 74% of patients followed by nephrologists for more than six months initiate hemodialysis with a CVC.

There are many reasons for the high incidence, high infection rates, high hospitalization rates, and excessive costs of care of CVCs,RPA noted in its September issue of RPA News. Despite the best efforts of physicians and dialysis providers to implement initiatives to improve vascular access, it remains a significant problem for the renal community. RPA, representing the practicing nephrologists in the U.S., believes that nephrologists must take the lead role in eradicating CVCs from our patients by accepting responsibility and accountability for resolving this situation.

The association is working with American Renal Associates, the Centers for Dialysis Care, DaVita, Dialysis Clinic Inc., Fresenius Medical Care, Northwest Kidney Centers, Renal Advantage, Renal Ventures, the National Renal Administrators Association and other public entities such as the Quality Improvement Organizations (QIOs), the Fistula First Breakthrough Initiative (FFBI) and the ESRD Networks to establish the VAI. The initiative includes a number of support documents, which are accessible on the RPA website.

Several are noted below.

1) A statement providing background on the issue and outlining goals and action steps
2) A document outlining the role of the nephrologist in this effort, including:
Nephrologists should establish a working relationship with an access surgeon who supports the goals of the FFBI program
Nephrologists should offer vessel mapping results and discussions of the anticipated patient start date for RRT with the surgeon.
There should also be less than a three-week scheduling time to get the patient both an appointment with a surgeon and a vascular access procedure.
For any patient whose only option is to start dialysis with only a CVC, the nephrologist should ensure that a plan is in place for a permanent access without a CVC within 80 days.
3) A parallel document outlining the role of dialysis providers in achieving the VAI objectives
4) A letter to the vascular surgical community seeking their cooperation in this effort
5) a letter to the QIOs participating in the Centers for Medicare & Medicaid Services CKD pilot quality improvement project urging them to support the VAI
6) a letter to be sent to the Chief Executive Officers of selected hospitals soliciting their help with the VAI
7) a letter from RPA leadership to RPA membership urging participation in the project.

The group has also developed two tools intended to facilitate the work of the vascular surgeon, a surgical referral template document, and a bulleted list of recommendations to the surgeon on surgical management of patients with CKD stages 4 or 5. All documents from the VAI are accessible on the RPA website.     

More info: http://www.nephronline.com/features.asp?F_ID=572