A Streamlined Approach to Arteriovenous Fistula and Arteriovenous Graft Maintenance
Lindsey Korepta, MD1, Peter Wong, MD2.
1MSU/GRMEP Vascular Surgery Residency, East Grand Rapids, MI, USA, 2Spectrum Health Hospital, Grand Rapids, MI, USA.
OBJECTIVES:
Arteriovenous fistula (AVF) and arteriovenous graft (AVG) management is of utmost importance to maintain hemodialysis access. With an increasing prevalence of chronic kidney disease and diabetes mellitus, it is imperative to not only pursue a fistula first strategy, but to develop a follow-up protocol in which to prolong primary patency, primary assisted patency, and secondary patency.
METHODS:
In instituting a hemodialysis access patient process protocol, we created a multi-physician committee to choose the parameters that our protocol would include. We used several reference texts including the NKF KDOQI Guidelines Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates to create our definition of inadequate hemodialysis and identify problems with access. After identification of access problems, the appropriate column within the flowsheet of Figure 1 was followed, which often automatically resulted in operative interventions.
RESULTS:
As previously published, we were able to achieve a high primary assisted patency rate of 97% in our arteriovenous fistula creation population, by following this AVF patient process protocol.1 We obtained these results with the implementation of a flowsheet for the management of our AVF and AVG patients (Figure 1).
CONCLUSIONS:
After implementation of such a protocol, we have seen a decrease in the time it takes to get the patient to the operating room for access salvage and an improvement in the overall assisted patency rates of our hemodialysis accesses.
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