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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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"Save the Vein" Initiative in Children With CKD: A Quality Improvement Study.
Nisha S Singh1, JoLynn Grimes1, Gina K Gregg1
1Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO.
Summary
An initiative successfully increased peripheral intravenous (PIV) catheter placement in the dominant arm for pediatric patients with chronic kidney disease (CKD). This vein preservation strategy is crucial for future arteriovenous fistula creation in children requiring long-term hemodialysis.
Area of Science:
- Pediatric Nephrology
- Vascular Access Management
- Quality Improvement in Healthcare
Background:
- Arteriovenous fistulas are preferred for hemodialysis, but prior peripheral intravenous (PIV) catheter use can compromise future fistula creation.
- Pediatric patients with chronic kidney disease (CKD) may require lifelong dialysis, making vein preservation critical.
- Limited options for arteriovenous fistula creation pose a significant challenge for long-term pediatric hemodialysis.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative focused on increasing PIV catheter placement in the dominant arm of hospitalized pediatric patients with advanced CKD.
- To preserve vascular integrity in pediatric CKD patients, thereby safeguarding options for future arteriovenous fistula creation.
- To reduce the incidence of PIV catheter placement in the non-dominant arm among pediatric CKD patients.
Main Methods:
- A quality improvement initiative was implemented at a single children's hospital.
- Key interventions included multidisciplinary team, patient, and parent education on vein preservation.
- Standardized protocols involved electronic medical record notes, "restricted extremity" arm bands, and vascular access team involvement.
Main Results:
- Baseline PIV catheter placement in the dominant arm was 47% (34/72), significantly increasing to 93% (345/371) post-initiative.
- In children under 5 years old, dominant arm PIV placement rose from 25% (2/8) to 94% (58/62).
- The study observed a reduction in PIV placement in the antecubital vein, with only 10% (38/371) occurring there post-initiative.
Conclusions:
- Education and standardized processes for vein preservation can effectively guide PIV catheter placement in pediatric CKD patients.
- This initiative demonstrates a successful strategy to preserve vasculature, enhancing future arteriovenous fistula options.
- Implementing targeted PIV placement protocols is vital for long-term vascular health in pediatric CKD management.
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