On August 13, 2020 the American Hospital Association (AHA) along with the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and Association of periOperative Registered Nurses (AORN) released a Joint Statement: Roadmap for Maintaining Essential Surgery During COVID-19 Pandemic. This new joint statement provides a list of principles and considerations to guide physicians, nurses, and hospitals and health systems as they provide essential care to their patients and communities. The joint statement builds on the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic released by the AHA, ACS, ASA, and AORN on April 17, 2020.
Category: Vascular Access
Mac Toolkits; Transplant, Transitions, Medications
The National Forum of ESRD Networks has introduced or updated several Medical Advisory Council (MAC) Toolkits. Two new Kits include the Transplant Toolkit and the Medication Conversion Toolkit. The Transitions of Care Toolkit was updated in mid-April. Find them all at http://esrdnetworks.org/resources/toolkits/mac-toolkits-1, along with the existing Home Dialysis Toolkit, Medical Directors Toolkit, QAPI Toolkit, Medication Reconciliation Toolkit, Catheter Reduction Toolkit, Vaccination Toolkit, and Assurance of Diabetes Care Coordination Toolkit.
NKF Spring Clinical Meetings, Boston
The National Kidney Foundation 2019 Spring Clinical Meetings (SCM19) present a unique opportunity for renal health care providers to learn new developments related to all aspects of nephrology. An important objective of SCM19 is to present the latest insights into CKD care through a combination of interesting courses, practical workshops, thought-provoking symposia and insightful debates. SCM19 will be held May 8-12, 2019 in Boston MA. In-person registration is allowed, but many registration fees are discounted if you register online before May 6.
Extra-cost pre-conference course topics on May 8 include dialysis success, vascular access, ultrasound, supportive care, and updates on new developments in transplant, critical care, and glomerular disease. Extra-cost lunch workshop topics will include vascular access, electrolytes, hyponatremia, glomerular disease, reproductive health, hypertension, communication, and board review. For those unable to attend in person, live-streamed conference sessions will be available on burnout, obesity, safety, fluid management, opioids, social media, diabetes, community, lifestyle interventions, palliative care, and KDOQI update.
For more information and registration, see https://www.kidney.org/spring-clinical.
Making Dialysis Safer for Patients: Optimal Vascular Access
Register now for a free one-hour webinar with continuing education
This World Kidney Day, CDC and the Making Dialysis Safer for Patients Coalition invite you to a webinar presenting the infection risks associated with different vascular access types. Discussion will include strategies and recommendations for successful catheter reduction to prevent bloodstream infections.
Webinar: Making Dialysis Safer for Patients: Optimal Vascular Access
Date: Thursday, March 14, 2019
Time: 2:00 – 3:00 PM EDT
Registration: Click Here to Register (at no cost)
Join us this World Kidney Day for a presentation on “Incident Vascular Access and Risk of Bloodstream Infection Among New ESRD Patients Receiving Hemodialysis” followed by a conversation about achieving optimal vascular access for patient safety.
Featured Speakers:
Sophia Kazakova, MD, MPH, PhD; Division of Healthcare Quality Promotion, CDC.
Discussants:
• Vandana Dua Niyyar, MD, FASN, FNKF, FASDIN; Professor of Medicine, Division of Nephrology, Emory University.
• Tracy Jonelis, MD; Chief of Nephrology, Kaiser Permanente Northern California, San Francisco Medical Center
Moderators:
Priti Patel, MD, MPH and Ibironke Apata, MD; Division of Healthcare Quality Promotion, CDC.
Continuing Education: Accredited for physicians, nurses, pharmacists, certified health educators, public health professionals and other health professions.
Audio: Please note the audio for this webinar will come through your computer speakers. During the webinar, please ensure that your speakers are turned on and the volume is up. Thank you.
CDC Webinar on BSI and Incident HD Access
CDC will present a March 14, 2019 World Kidney Day webinar on Incident Vascular Access and Risk of Bloodstream Infection Among New ESRD Patients Receiving Hemodialysis, followed by a conversation about achieving optimal vascular access for patient safety. CME, CNE, CEU, CECH, CPE, and CPH continuing education credits are available. Find more information and register at https://cc.readytalk.com/registration/#/meeting=f8wbng3dtcpm&campaign=vq0d1qix86ac.
Reducing Catheter Rates By Preserving Vascular Access
Reducing facility vascular access rates has been a priority for CMS for many years. With proper and ongoing staff and patient education, patients are able to maintain healthy AV fistulas or grafts. Regular performance of the look, listen, feel check allows early detection of problems andimplementation of appropriate interventions to protect the access . The Look, Listen and Feel technique is a quick and effective way to assess a patient’s access prior to cannulation. This method can be taught to patients so that they can assess their own access on non-dialysis days. This is a simple method of monitoring that does not require any special equipment and can potential save a patient’s access. Photo source: ESRD National Coordinating Center.
For more information, click on the links below:
Strategies for Preventing Catheter-Related Bloodstream Infections in Hemodialysis Patients
A 2016 article in the International Journal of Nephrology and Renovascular Disease evaluates management strategies for preventing catheter-related bloodstream infections, with recognition that many patients begin hemodialysis (HD) with a catheter. The authors conclude that “Early efforts must be directed toward preventative care emphasizing placement of other vascular accesses or initiating an alternative dialysis modality, such as timely peritoneal dialysis (PD) to avert HD catheter placement before it becomes necessary.”
Findings include:
- “Urgent start PD” programs are a safe alternative to HD in patients without an established AV fistula or graft.
- Should no options exist outside of catheter placement, proper catheter care and infection control procedures implemented through educating and auditing dialysis unit staff as well as patients, are the first step in preventing infections.
- In high-risk groups for whom all other conservative measures to prevent infection have failed, the authors recommend consideration of antimicrobial lock (AML) therapy.
“Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies,”Int J Nephrol Renovasc Dis. 2016; 9: 95-103. Published online 2016 Apr 18. doi: 10.2147/IJNRD.S76826
How to Prevent, Diagnose, and Treat Hemodialysis Catheter-Related Infections
The best way to prevent infectious complications in dialysis patients is to avoid the use of central-venous catheters (CVC), when possible. However, this is not possible for some patients, and in those cases the adoption of prophylaxis protocols, early diagnosis and effective treatment of infectious complications are essential to improve outcomes. These are some of the conclusions reported in an article in the Journal of Vascular Access, which provides a comprehensive review of literature related to hemodialysis catheter – related infections as well as a discussion of prevention, diagnosis criteria and management of CVC-related infections in hemodialysis patients.
Vascular Access Reporting in CROWNWeb
CMS has tasked all dialysis facilities with ensuring that clinical data is accurately entered, tracked, and reported in CROWNWeb. To assist with this process, the Network encourages all facilities to compare their internal electronic medical records (EMRs) of patient level vascular access data with what has been entered in CROWNWeb on a monthly basis (both systems should be the same). The CROWNWeb Vascular Access in Use report can be used to support data validation.
If your organization utilizes batch submission, data in your EMRs upload to CROWNWeb. If there are discrepancies between the Vascular Access in Use report and your facility’s EMRs, please follow the guidelines provided in the Vascular Access Data Cleanup in CROWNWeb to reconcile the data.
Vascular access data is a clinical indicator for the Quality Incentive Program (QIP), and errors in reporting can affect payment and, ultimately, your facility’s scoring in Dialysis Facility Compare.
Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly
Central venous catheters (CVC) continue to remain a common modality of vascular access in end stage kidney disease patients maintained on hemodialysis. The increased morbidity and mortality associated with CVC, when compared to arteriovenous fistulas and grafts, is a serious health problem and a big challenge to the nephrology community. An article “Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly” written by Nabil J. Haddad, Sheri Van Cleef , Anil K. Agarwal and published in the Volume 10, 2017 issue of The Open Urology & Nephrology Journal, presents the pros and cons of CVC, in addition to the different complications and excessive economical costs related to their use.
According to the authors, a CVC is placed in the acute setting when immediate treatment can be lifesaving. For long term therapy though, the complications can be life threatening secondary to a poorly functioning catheter, central venous stenosis or blood stream infection (BSI).
The dysfunctional catheter leads to suboptimal dialysis clearance and impacts on the patients general wellness and quality of life. If bacteremia is noted by positive blood cultures the course of treatment requires long-term antibiotic therapy with the possibility of sepsis and extended hospitalization. Lastly the central venous stenosis (CVS) may require the patient to undergo both endovascular procedures and surgical intervention to correct the stenosis.
The authors conclude the best plan of care for the patient who requires renal replacement therapy is early referral to a nephrologist and vascular surgeon for placement of an arteriovenous fistula or a graft. Early intervention decreases the incidence of morbidity and mortality with the goal of improving patient outcomes, quality of life and financial stewardship of healthcare resources.
The full article can be found in The Open Urology & Nephrology Journal, 2012, 5, (Suppl 1: M3) 12-18, at https://benthamopen.com/FULLTEXT/TOUNJ-5-12