Change Concept 7

AVF placement in patients with catheters where indicated

  • 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.

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:

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.

Related Tools

Management of Patients with CVCs Algorithm

Revised 02/10
This algorithm/flow chart can be used by dialysis facilities to transition patients from CVC to AV fistulas.

Central Venous Catheter Tracking Tool

Developed 02/10
This Excel Spreadsheet can be used by dialysis facilities to track patients with CVCs until a permanent access is placed.

Patient Educational Flyer

Revised 04/11
One page flyer provides advantages and disadvantages of the three hemodialysis access types.  Should be used to educate patients and families about hemodialysis vascular access.  Spanish Version

Reducing Central Venous Catheter Infections Cause and Effect Diagram

Cause and effect (or “fishbone”) diagrams are a useful way to graphically display the possible causes of a certain effect. This diagram shows the various risk factors that can lead to central venous catheter (CVC) infection, grouped into four major categories: patient, caregiver, equipment, and environment.

Referral Form for Existing Hemodialysis Access

This form can be used by nephrologists to refer a patient with existing hemodialysis access to a surgeon or interventionalist. The form indicates the reason for referral and procedure requested, as well as current hemodialysis treatment and vascular access information.

Checklist of Indications for Hemodialysis Catheter Use

A tool for monthly, in-center monitoring/reporting of dialysis patients.