LTC and VA Resources for Patients, Family Members, Providers and other Stakeholders The table below lists possible root causes of high catheter utilization and potential interventions. Possible Root Causes Of High Catheter Utilization and Potential Interventions To Reduce The Long-Term Catheter Rate POSSIBLE ROOT CAUSES POTENTIAL INTERVENTIONS ESRD Management-Related Factors Increase educational awareness of benefits of Lack of valid information about long-term permanent internal access (AVF or AVG) for benefits of permanent internal access (AVF or patient’s optimal quality of life. Adopt belief AVG) and that catheter placement at certain that the preferred permanent vascular access sites may limit future access options is AVF. Provide recent copy of K-DOQI Practice Lack of knowledge about K-DOQI Guidelines Guidelines and familiarize facility staff with for vascular access contents Establish a vascular access program and select Failure to establish a vascular access program a coordinator or team for implementation and coordinator to implement and follow-up. and follow-up. Integrate into facility’s QI program. Failure of nephrologist, surgeon, or ESRD Provide patient education, preferably team to educate patients (preferably or at the beginning of dialysis, about about risks/benefits of vascular risks/benefits of vascular access options. access options and need to protect potential Adopt belief that the preferred permanent access sites vascular access is AVF. Late referral of patient by nephrologist (or primary physician) to vascular surgeon for Use of vascular access assessment and permanent access placement, including referral algorithms. Refer patient to facility waiting for completion of transplant vascular access coordinator (or team) for evaluation before making access plans. assessment and follow-up. Nephrologist did not refer patient to vascular surgeon in timely manner Lack of surgeon preference for AVFs Adopt belief that the preferred permanent Lack of surgical training/experience in placing vascular access is AVF. AVFs. Encourage education/expertise in placing Catheter placed surgically because it is faster AVFs. and technically easier to accomplish. Refer patient to surgeon with expertise in
LTC and VA Resources for Patients, Family Members, Providers and other Stakeholders The table below lists possible root causes of high catheter utilization and potential interventions. Possible Root Causes Of High Catheter Utilization and Potential Interventions To Reduce The Long-Term Catheter Rate POSSIBLE ROOT CAUSES POTENTIAL INTERVENTIONS ESRD Management-Related Factors Lack of valid information about long-term benefits of permanent internal access (AVF or AVG) and that catheter placement at certain sites may limit future access options Increase educational awareness of benefits of permanent internal access (AVF or AVG) for patient’s optimal quality of life. Adopt belief that the preferred permanent vascular access is AVF. Lack of knowledge about K-DOQI Guidelines for vascular access Provide recent copy of K-DOQI Practice Guidelines and familiarize facility staff with contents Failure to establish a vascular access program and coordinator to implement and follow-up. Establish a vascular access program and select a coordinator or team for implementation and follow-up. Integrate into facility’s QI program. Failure of nephrologist, surgeon, or ESRD team to educate patients (preferably about risks/benefits of vascular access options and need to protect potential access sites Provide patient education, preferably or at the beginning of dialysis, about risks/benefits of vascular access options. Adopt belief that the preferred permanent vascular access is AVF. Late referral of patient by nephrologist (or primary physician) to vascular surgeon for permanent access placement, including waiting for completion of transplant evaluation before making access plans. Nephrologist did not refer patient to vascular surgeon in timely manner Use of vascular access assessment and referral algorithms. Refer patient to facility vascular access coordinator (or team) for assessment and follow-up. Lack of surgeon preference for AVFs Lack of surgical training/experience in placing AVFs. Catheter placed surgically because it is faster and technically easier to accomplish. Adopt belief that the preferred permanent vascular access is AVF. Encourage education/expertise in placing AVFs. Refer patient to surgeon with expertise in