A Centralized Vascular Access Service Expedites Placement of Tunneled Catheters and Helps Track the Fate of End Stage Renal Disease Patients
Mark J. Bailey, PhD, Hanna J. Barnes, BA, Daniel K. Han, MD, Amy Brito, RN, Francis S. Nowakowski, MD, Rami Tadros, MD, Ageliki Vouyouka, MD, Roopa Kohli-Seth, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
OBJECTIVES: Tunneled catheters (TCs) with and without subcutaneous ports are needed in patients who require prolonged vascular access. Delays in the placement of TCs can lead to increased lengths of stay and higher hospital costs. To ensure placement of the appropriate catheter and decrease wait times, a centralized Vascular Access Service Team (VAST) was created at a large academic medical center. The objective of this review was to examine the efficiency of VAST.
METHODS: VAST is comprised of physicians from multiple departments in the hospital (Vascular Surgery, Interventional Radiology, Critical Care, Nephrology, Interventional Cardiology, and Surgical Oncology), nurses with advanced knowledge of intravenous access techniques, and operating room coordinators. A centralized consult service was created where patients undergo a uniform evaluation for appropriate vascular access. A review of prospectively collected data after VAST creation was performed for all patients undergoing TC placement in 2018 (n=415). Records from patients who underwent tunneled catheter placement from January 2016-November 2016 were retrospectively analyzed to form a comparison cohort (n=147).
RESULTS: In 2018, VAST placed 415 TCs: 59 subcutaneous ports, 140 Hickman catheters, and 214 permacaths for hemodialysis. Indications for TC placement included chemotherapy, hemodialysis, parenteral nutrition, and long-term intravenous antibiotics. Prior to the implementation of VAST, 111 (75.5%) of patients underwent TC placement within two days compared to 375 (90.3%) after VAST implementation and mean wait time was reduced from 2.04 business days to 1.35 business days (p<0.001). Of the patients eligible for AVF/AVG creation and not expected to have renal recovery, all patients were able to get simultaneous consultations for tunneled catheter and AVF/AVG creation compared to 35% prior to VAST. In addition, 8 patients (12.3%) were able to have permanent access created simultaneously with TC placement compared to 2 (9.5%) prior to VAST.
CONCLUSIONS: A Vascular Access Service Team is effective in expediting TC placement, evaluating patients for the appropriate catheter type, and coordinating permanent dialysis access planning.
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