Thank You for Joining Us! We Will Begin Shortly
Tunneled Catheter Avoidance- Seven Simple Strategies Anil Agarwal, MD, FASN, FNKF, FACP Professor of Clinical Medicine Director, Interventional Nephrology Chief, Section of Nephrology at University Hospital East Wexner Medical Center at The Ohio State University September 7, 2016
We Ask That You: Be present and engaged in our speaker presentations Remain open- minded and respectful in hearing other’s opinions Actively participate in the discussion Speak up on the line, send in comments in the chat Be mindful of muting your phone when not speaking Don’t place the call on hold, instead disconnect your line and rejoin the call when able 3
Objectives Discuss catheters as a necessary evil Factors promoting catheter utilization Suggest strategies to avoid catheters 4
More Than 80% of Patients Start HD with a Catheter in US 5 fold greater mortality in first 90 days on HD Not a failure of technology or biology Dismal failure of communication and logistics!! Process of Care USRDS 2013 5
Any Prolongation in Catheter Duration is Bad! 15% infection rate Lee et al. AJKD
Catheters Kill! 5 fold increase in mortality HD/PD CVC Peak mortality rate with a CVC in 1 st 90d = 70 per 100 patient years Peak mortality rate with an AVF in 1 st 90d = 15 per 100 patient years Perl et al. JASN 2011
Fate of Catheter Through 180 Days
Bottom Line (Survival and Cost) Patients with a catheter (TDC) die quicker and cost more! Patients with an AVF or AVC live longer and cost less!
Strategy #1 to Avoid Catheters – Early Referral 30-40% are referred late to the nephrologist <4 months before starting HD 90% 62%
Strategy #2 – Educate the Patient Avoid patient refusal through education Feb 2010 Results
Strategy #3 – Preserve the Veins Peripheral and central veins should be saved! Avoid IVs, PICC lines, CVCs
Strategy #4 – For Failing AVF/AVG – Create a Secondary AV Fistula Slayden et al. Semin Dial. 2008 Sep-Oct;21(5):474
Strategy #5 – Early Cannulation AV Grafts ePTFE Acuseal 40% Acuseals cannulated within 72 hrs
For Patient Needing Urgent Dialysis ( 1 – 2 Weeks) Patient needs urgent dialysis X (not today but in 1-2 wks) 3-4 months of Rapid Early Use WAIT a TDC with start PD AV Graft multiple AVF interventions 3-4 wks 3-4 wks 6-12 weeks Standard PD Standard PTFE AVF
Strategy #6 – Don’t Forget the “Good Catheter”
Strategy #6 – For a Patient Needing Immediate Dialysis Patient needs immediate dialysis (pulm edema, BUN = 150, Creat. = 20) Temp. catheter, HD started X Early Urgent Use start PD 3-4 months of Grafts a TDC with multiple AVF Secondary AVF interventions
Strategy #7 – The Gift of Life!
The Ultimate Strategy – Develop A Catheter Last Culture Use a Fistula First + catheter Last Catheter out , and Catheter never in paradigm
Back to the Future ? Place Scribner Shunt- then create a secondary AVF or AVG
Thanks to Prabir Roy-Chaudhury, MD for making available many of his slides
Any Questions ?
Objectives Discuss catheters as a necessary evil Factors promoting catheter utilization Suggest strategies to avoid catheters 23
IPRO ESRD Network of New England (Network 1) Danielle Daley, MBA Jenna Vonaa Executive Director Sr. Program Support Coordinator ddaley@nw1.esrd.net jvonaa@nw1.esrd.net Krystle Gonzalez Jaya Bhargava, PhD, CPHQ Operations Director Sr. Data Coordinator jbhargava@nw1.esrd.net kgonzalez@nw1.esrd.net Kristin Brickel, RN, MSN, MHA, CNN Heather Camilleri, CCHT Quality Improvement Coordinator Quality Improvement Director kbrickel@nw1.esrd.net hcamilleri@nw1.esrd.net Brittney Jackson, LMSW, MBA Merari Rosario, MHA Patient Services Director Community Outreach Coordinator mrosario@nw1.esrd.net bjackson@nw1.esrd.net 1952 Whitney Avenue, 2 nd Floor, Hamden, CT 06517 Phone: (203) 387-9932 Fax: (203) 389-9902
IPRO ESRD Network of New York (Network 2) Susan Caponi, RN, BSN, MBA, CPHQ Laura Wright CEO, ESRD Program Administrative Coordinator II scaponi@nw2.esrd.net lwright@nw2.esrd.net Nicole Howell, BA ITIL v3 Sharon Lamb Information Management Director Data Coordinator nhowell@nw6.esrd.net slamb@nw2.esrd.net Carol Lyden, RN, MSN, CNN Jeanine Pilgrim , BS Director, Quality Improvement Quality Improvement Coordinator clyden@nw2.esrd.net jpilgrim@nw2.esrd.net John Cocchieri Anna Bennett Data Coordinator, QI Education Coordinator jcocchieri@nw2.esrd.net abennett@nw2.esrd.net Erin Baumann, LMSW Emancia Brown, MSW Patient Services Director Community Outreach Coordinator ebaumann@nw2.esrd.net ebrown@nw2.esrd.net 1979 Marcus Avenue, Lake Success, NY 11042 Phone: (516) 209-5578 Fax: (516) 326-8929
IPRO ESRD Network of the South Atlantic (Network 6) Shannon Wright, BSW, PMP, ITIL v3 Ariana Lucido, BS Executive Director Operations Manager swright@nw6.esrd.net alucido@nw6.esrd.net Emily Watson Anna Bennet Education Coordinator Program Support Coordinator abennet@nw6.esrd.net ewatson@nw6.esrd.net Nicole Howell, BA, ITIL v3 Tracey Howard Data Coordinator Data Manager nhowell@nw6.esrd.net thoward@nw6.esrd.net Dansowaa “Dee” Ahima Susan Waite, MEd, BSN, ANP, CNN Data Coordinator Quality Improvement Coordinator swaite@nw6.esrd.net dahima@nw6.esrd.net Wambui Kungu, BS Melissa Arrington, MSW Quality Improvement Coordinator Patient Services Director wkungu@nw6.esrd.net marrington@nw6.esrd.net 909 Aviation Parkway, Suite 300, Morrisville, NC 27560 Phone: (919) 463-4500 Fax: (919) 388-9637
IPRO ESRD Network of the Ohio River Valley (Network 9) Victoria Cash, MBA, BSN, RN Michelle Kaszowski Executive Director Sr. Program Support Coordinator vcash@nw9.esrd.net mkaszowski@nw9.esrd.net Wendy Cable, BA, RN VACANT Assistant Director, Information Management Data Coordinator wcable@nw9.esrd.net TBD Debbie DeWalt, MSN, BSN, RN Susan Swan-Blohm, BS, OCDT Assistant Director, Quality Improvement Quality Improvement Coordinator ddewalt@nw9.esrd.net sswan-blohm@nw9.esrd.net Andrea Bates, MSW, LISW Nina Pollard, MPH Patient Services Coordinator Community Outreach Coordinator npollard@nw9.esrd.net abates@nw9.esrd.net 3201 Enterprise Parkway, Suite 201, Beachwood, OH 44122 Phone: (216) 593-0001 Fax: (216) 593-0101
For more information: IPRO ESRD Program http://esrd.ipro.org NW1: quality@nw1.esrd.net NW2: qualityimprovement@nw2.esrd.net NW6: info@nw6.esrd.net NW9: quality@nw9.esrd.net CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY 11042-1002 www.ipro.org
Recommend
More recommend
