O8
AIMING FOR AND MAINTAINING A GREATER THAN 85% HAEMODIALYSIS
PATIENTS WITH AVF/GRAFTS
Bullingham, J, Williams A
Gloucestershire Hospitals NHS Foundation Trust
PROBLEM: Pre 2003 as a directorate we had a dedicated surgeon who performed the
majority of our weekly, 3 case elective surgical procedures. This often resulted in on the day
cancellations and inappropriate referrals, highlighting inappropriate use of resources. In
2003 we created an access nurse/ co-ordinator post to help maintain and improve our
AVF/AVG rates above 80%, and to complement this in 2004 we introduced a ‘one-stop pre
surgical assessment clinic’ this resulted in patients requiring fewer hospital visits (50%
reduction). We continued to see improvements until June 09. We put this down to increasing
numbers of referrals and an increased number of patients attending dialysis, in 2003 we had a
population of 135, to date we have a population of 201. In September 2009 we set up a
monthly Renal X-ray meeting consisting of Renal Consultants, SPR’s, Vascular Technician,
Vascular Surgeons, Radiologist and Vascular Access Nurse. By July 2010 we had 89% of our
HD population on AVF, but again this was beginning to drift down and the question of ‘what
to do’ was again discussed.
PURPOSE: To improve the patient numbers dialyzing on AVF/AVG to Renal Association
Guidelines and to minimise those who do not have fistulae who are already on dialysis as this
will become a financial necessity and to increase efficiency with the recourses available to
facilitate the increase of patients requiring Haemodialysis.
DESIGN: In January 2011 we introduced a ‘Fast Track’ referral process for patients with
CVC lines. This primarily involved a new vascular surgeon who joined the Trust in 2009
committing 3 extra slots per month to Renal, the Vascular Laboratory to extra sessions and
pre and post follow up appointments in out patient clinic.
FINDINGS: In October 2011 we were maintaining an 86% AVF/AVG use in our dialysis
population. This was achieved by an increased efficiency with the recourses available for the
increased numbers of procedures required.
140
120
100
80
AVF
PTFE
60
40
20
0
2003
2005
2007
2009
2011
CONCLUSION: In order to maintain and improve our aim of >85% of patients dialysing on
AVF/AVG we need the continued commitment from the Renal Consultants, Vascular
Surgeons and Interventional Radiology.