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Fistula maturation from surgery to usage to catheter removal: Effect of a novel protocol for hemodialysis fistula maturation assistance on reduction of hemodialysis catheter dwell time
ABSTRACT
Background:
K-DOQUI guidelines call for early arterio-venous fistula usage in patients with End Stage Renal Disease (ESRD); however, there has often been a significant delay before fistulas can be used to allow for fistula maturation; this has proven to be a barrier to early fistula usage. Many patients are therefore forced to endure prolonged catheter dwell times, with increased infection rates until their fistulas are mature enough to be used. Balloon-assisted fistula maturation is a technique to help accelerate fistula maturation and therefore diminish the time before a fistula can be used. The technique has been performed since, with well documented outcomes. We developed a novel protocol for assisting in the maturation of hemodialysis fistulae in order to reduce the amount of time catheters are required in these patients.
Materials and Methods:
We retrospectively analyzed 83 patients, who had either a radiocephalic arteriovenous fistula at the wrist or a brachiocephalic arteriovenous fistula at the antecubital fossa over a 24 month period, all of whom had the fistulas placed in either a fully JACAHO-compliant outpatient surgical center or in the hospital setting. We followed patients using the following protocol: at one week post-op for a wound check, then at 2 weeks from the surgery for a fistulogram with possible intervention, and at 4 weeks after the surgery for a 2nd fistulogram with possible intervention. When the fistula was at least 6 mm in size by ultrasound (in compliance with K-DOQUI guidelines), the fistula was used, with patients returning in 1-2 weeks for catheter removal.
Results:
The mean time for first time fistula usage was 45.4 days, which represents a significant decrease from the standard of care. Complications with fistula usage included small hematomas and ecchymosis.
Conclusion:
Our data show that the use of a novel balloon-assisted fistula maturation protocol in the early postoperative period is a safe and effective method for decreasing the amount of time before a fistula can be used, with minimal complications, thereby theoretically significantly reducing catheter dwell times and associated morbidity and mortality.