Early Access Protocol Reduces Time to Arteriovenous Fistula Cannulation and Catheter Dependency

Autologous arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to lower complication rates and superior long-term patency. Historically, time to first cannulation has been prolonged, leading to prolonged catheter dependence. This study evaluates whether an early access protocol can safely reduce time to AVF cannulation and therefore permacath removal.

A retrospective review was conducted on all patients who underwent autogenous AVF creation with preexisting dialysis catheters at our institutions between July 2018 and October 2024. Patients were grouped by protocol: those from 2018 to 2021 (Standard Protocol) and those from 2021 to 2024 (early access protocol). Time to first cannulation and time to dialysis catheter removal were compared between groups. Statistical analysis was performed utilizing the Shapiro-Wilk test, 2 tailed t-test, Wilcoxon signed-rank tests, and chi-squared tests with significance set at P < 0.05.

Of the 286 AVFs that were created during the study period, 128 met inclusion criteria with 77 patients in the early access protocol group and 51 in the standard protocol group. As shown in Table 1, patients in the early access protocol had significantly shorter times to cannulation (41.6 ± 23.8 days vs. 57.9 ± 41.2 days, P = 0.01) and permacath removal (98.3 ± 55.4 days vs. 133.6 ± 71.1 days, P < 0.01) than those in the standard protocol. There were no significant differences in sex, American Society of Anesthesiologists class, tobacco use, laterality of fistula, or complication rates. Although not statistically significant, there was a trend in the early access protocol cohort for increased adjunctive procedures.

Our early access protocol significantly reduced the time to AVF cannulation and catheter removal without increasing complication rates. These findings support the implementation of early access strategies to improve time to AVF cannulation rates, reduce catheter-related risks, and enhance overall vascular access outcomes.