A multidisciplinary team approach to increasing AV fistula creation

Area of Science:

• Nephrology
• Vascular Surgery
• Healthcare Management

Background:

• High patient comorbidity presents challenges in vascular access for dialysis.
• Previous approaches led to frequent use of AV grafts and catheters, with associated complications.
• Lack of focused leadership and education hindered optimal vascular access strategies.

Purpose of the Study:

• To evaluate the impact of a multidisciplinary vascular access team on dialysis access outcomes.
• To demonstrate the effectiveness of a structured approach in reducing reliance on AV grafts and catheters.
• To highlight the critical role of nephrologist leadership in vascular access management.

Main Methods:

• Implementation of a multidisciplinary vascular access team with dedicated leadership.
• Mandatory preoperative vein mapping and surgical planning for all patients.
• Comprehensive education programs for all team members, from fellowship to staff levels.
• Initiation of fistula creation seminars for healthcare professionals.

Main Results:

• Complete elimination of arteriovenous (AV) graft placement within four years.
• Exclusive use of fistulae with acceptable rates of catheter utilization.
• Significant reduction in thrombotic and infectious complications associated with vascular access.

Conclusions:

• A multidisciplinary vascular access team, led by nephrologists, is crucial for optimizing dialysis access.
• Structured organization, mandatory vein mapping, and continuous education are essential for success.
• This model demonstrates improved patient outcomes and reduced complications in vascular access for hemodialysis.