A Vascular Access Coordinator Improves the Prevalent Fistula Rate
A Vascular Access Coordinator Improves the Prevalent Fistula Rate
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DOI：
10.1111/j.1525-139x.2011.00961.x
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发表时间：
2012-03-01
影响因子：
1.6
通讯作者：
Aronoff, George
中科院分区：
文献类型：
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作者：
Dwyer, Amy;Shelton, Paula;Aronoff, George
医疗保险和医疗补助服务中心将流行的动静脉瘘（AVF）率设定为66%作为国家标准。为了检验使用临床血管通路协调员可以增加大型肾脏病组实践中AVF发生率的假设，我们实施了一项由经过培训的血管通路协调员（VAC）领导的积极的多学科血管通路改善计划。2009年初，我们制定了经所有医生批准的血管通路护理方案，并由VAC护士实施。我们回顾性审查了2008年1月至2010年12月的网络血管通路数据报告。数据显示，在实施由VAC领导的全面访问计划后，AVF的流行率从50%上升到65%。移植物的数量减少了，而使用超过90天的透析导管的百分比减少了一半。这些数据表明，尽管透析开始时导管率不变，但使用VAC实施积极的多学科入路计划可显著增加AVF率，同时减少移植物和导管的普遍使用。
The Centers for Medicare and Medicaid Services set the prevalent arteriovenous fistula (AVF) rate of 66% as a national standard. To test the hypothesis that the use of a clinical vascular access coordinator could increase the rate of AVF in a large Nephrology group practice, we implemented an aggressive, multidisciplinary vascular access improvement program led by a trained vascular access coordinator (VAC). In early 2009, we established protocols, approved by all physicians, for the care of vascular access and implemented by a nurse VAC. We retrospectively reviewed Network vascular access data reports from January 2008 through December 2010. The data show that after the implementation of a comprehensive access program led by a VAC, the prevalent AVF rate increased from 50% to 65%. The number of grafts decreased while the percentage of dialysis catheters used for more than 90 days was cut in half. These data suggest that despite an unchanged catheter rate at dialysis initiation, the use of a VAC implementing an aggressive, multidisciplinary access program can significantly increase the AVF rate while decreasing grafts and prevalent catheter use.