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Change Concept #7
AVF 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.
Changes for Improvement
Frequently Asked Questions
Related Literature
Related Tools
Related Resources
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.
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Changes for
Improvement:
Develop a Protocol for Catheter Indications and Removal
Nephrologists should make every effort not to admit "catheter only" patients to the clinic. Require "catheter only" patients’ nephrologists to document a plan for permanent access. Once patients arrive in the unit with a catheter only, they become part of the "catheter culture" and it becomes very difficult to counsel them to change.
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Changes for Improvement:
Track All Catheter Patients for Early Removal of Catheters
Develop and implement protocols to track all catheter patients for early removal of catheters.
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