The use of vascular access audit and infections in home hemodialysis

Abstract

Vascular access-related infection is an important adverse event in home hemodialysis (HHD). We hypothesize that errors in self-cannulation or manipulation of dialysis vascular access are associated with increased incidence of access-related infection. We conducted a retrospective cohort study of all prevalent HHD patients at the University Health Network. All vascular access-related infections were recorded from 2006 to 2013. Errors in dialysis access were ascertained by nurse-administered vascular access checklist. Ninety-two patients had completed at least one vascular access audit. Median HHD vintage was 2.3 (0.9-5.0) years in patients with appropriate vascular access technique and 5.8 (1.5-9.4) years in patients with erroneous vascular access technique. The overall rate of infection between patients with and without appropriate vascular access technique was similar (0.27 and 0.28 infections per year, P = 0.166). Among patients who were identified with errors in dialysis access manipulation, patients with five or more errors were associated with higher rate of access-related infection (mean of 0.47 vs. 0.16 infection per patient-year, P < 0.001). The use of vascular access audit is a feasible strategy, which can identify errors in vascular access technique. Patients with a longer median HHD vintage are associated with higher risk of inappropriate vascular access technique. Patients with multiple errors in vascular access technique are associated with a higher risk of dialysis access-related infection. Prospective evaluation of the impact of vascular access audit on adverse vascular access events is warranted.

The use of nurse‐administered vascular access audit in home hemodialysis patients: A quality initiative

“…Within the practice of home hemodialysis, frequent cannulation or connection to vascular access, unsupervised setting of the home, and varying skill level of home hemodialysis patients are speculated potential risk factors for dialysis access‐related infections . To understand patient reported errors, we had previously reported on the use of an audit tool . It is encouraging to note that patient errors can be reduced with subsequent audits.…”

“…Audits were performed through either direct procedure observation or through verbal answers. Details of vascular access audit have been previously published …”

“…Known risk factors for dialysis related infection include the use of central venous catheter (CVC) and button hole cannulation technique . Given that patients perform self‐cannulation or connection, patient reported technique is a potentially modifiable risk factor for vascular access complication . There is a paucity of information documenting patient reported technique and its association with future complications.…”

“…There is a paucity of information documenting patient reported technique and its association with future complications. Our group had previously reported on the use of a nurse‐administered vascular access checklist in assessing patients’ techniques in vascular access connection or cannulation . In this quality initiative, we aimed to determine the feasibility of vascular access checklist and its clinical utility to decrease the number of patient reported vascular access errors.…”

The Burden of Harm—What Is the Ideal Vascular Access for Home Hemodialysis?

“…It would be interesting to examine an international multicenter analysis that accounts for different home HD practices, cannulation techniques, and prescriptions to accurately investigate the risk of vascular access type in home HD. The precise estimation of vascular access risk will form the foundation to identify potential interventions to reduce these associated risks (11).…”