Change Concept 7: AV Fistula Placement in Patients with Catheters Where Indicated

Higher catheter use is associated with increased infection, morbidity, mortality, and hospitalization. Evaluation and mapping of catheter patients is crucial to facilitate the placement of AV fistulae. While catheters are necessary in some circumstances (e.g., while an AV fistula matures), the increasing prevalence of catheters in the United States is a serious health risk to patients. Strategies for reducing the number of catheters include early referral to nephrologists, monitoring and maintenance (so that accesses can be repaired before a catheter needs to be placed), and planning for a permanent access before the patient leaves the hospital.

• Regardless of prior access (e.g. AV graft), nephrologists and surgeons evaluate all catheter patients as soon as possible for AVF, including mapping as indicated.
• Facility implements protocol to track all catheter patients for early removal of catheter.

Changes for Improvement

Evaluate All Catheter Patients for an AVF

Regardless of prior access (e.g., AV graft), nephrologists and surgeons should evaluate all catheter patients as soon as possible for an AV fistula, including mapping as indicated.

Develop a Protocol for Catheter Indications and Removal

Patients with a “catheter only” should be reviewed and discussed by the vascular access team.  A documented plan for permanent vascular access evaluation and placement should be part of the patient’s permanent medical record.

Track All Catheter Patients for Early Removal of Catheters

Develop and implement protocols to track all catheter patients for early removal of catheters.