Thank You for Joining Us! We Will Begin Shortly Tunneled Catheter - - PowerPoint PPT Presentation

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Thank You for Joining Us! We Will Begin Shortly Tunneled Catheter - - PowerPoint PPT Presentation

Jun 16, 2023 182 likes •477 views

Thank You for Joining Us! We Will Begin Shortly Tunneled Catheter Avoidance- Seven Simple Strategies Anil Agarwal, MD, FASN, FNKF, FACP Professor of Clinical Medicine Director, Interventional Nephrology Chief, Section of Nephrology at

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Thank You for Joining Us! We Will Begin Shortly

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Tunneled Catheter Avoidance- Seven Simple Strategies

Anil Agarwal, MD, FASN, FNKF, FACP

Professor of Clinical Medicine Director, Interventional Nephrology Chief, Section of Nephrology at University Hospital East Wexner Medical Center at The Ohio State University September 7, 2016

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3

We Ask That You:

  • Be present and engaged in our speaker presentations
  • Remain open-minded and respectful in hearing other’s opinions
  • Actively participate in the discussion
  • Speak up on the line, send in comments in the chat
  • Be mindful of muting your phone when not speaking
  • Don’t place the call on hold, instead disconnect your line and

rejoin the call when able

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Objectives

  • Discuss catheters as a necessary evil
  • Factors promoting catheter utilization
  • Suggest strategies to avoid catheters

4

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More Than 80% of Patients Start HD with a Catheter in US

  • 5 fold greater mortality in first

90 days on HD

  • Not a failure of technology or

biology

  • Dismal failure of

communication and logistics!!

  • Process of Care

5

USRDS 2013

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15% infection rate

Lee et al. AJKD

Any Prolongation in Catheter Duration is Bad!

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CVC HD/PD

Peak mortality rate with a CVC in 1st 90d = 70 per 100 patient years Peak mortality rate with an AVF in 1st 90d = 15 per 100 patient years

Perl et al. JASN 2011

5 fold increase in mortality

Catheters Kill!

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Fate of Catheter Through 180 Days

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  • Patients with a catheter (TDC) die quicker and cost more!
  • Patients with an AVF or AVC live longer and cost less!

Bottom Line (Survival and Cost)

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90% 62%

  • 30-40% are referred late to the nephrologist <4 months

before starting HD

Strategy #1 to Avoid Catheters – Early Referral

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Feb 2010 Results

  • Avoid patient refusal through education

Strategy #2 – Educate the Patient

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  • Peripheral and central veins should be saved!
  • Avoid IVs, PICC lines, CVCs

Strategy #3 – Preserve the Veins

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Slayden et al. Semin Dial. 2008 Sep-Oct;21(5):474

Strategy #4 – For Failing AVF/AVG – Create a Secondary AV Fistula

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40% Acuseals cannulated within 72 hrs

Acuseal ePTFE

Strategy #5 – Early Cannulation AV Grafts

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Patient needs urgent dialysis (not today but in 1-2 wks) WAIT Rapid start PD

X

3-4 months of a TDC with multiple AVF interventions

6-12 weeks AVF 3-4 wks Standard PD 3-4 wks Standard PTFE

Early Use AV Graft

For Patient Needing Urgent Dialysis ( 1 – 2 Weeks)

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Strategy #6 – Don’t Forget the “Good Catheter”

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Patient needs immediate dialysis (pulm edema, BUN = 150, Creat. = 20)

  • Temp. catheter, HD

started

Early Use Grafts Secondary AVF Urgent start PD

X

3-4 months of a TDC with multiple AVF interventions

Strategy #6 – For a Patient Needing Immediate Dialysis

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Strategy #7 – The Gift of Life!

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  • Use a Fistula First + catheter Last
  • Catheter out, and
  • Catheter never in paradigm

The Ultimate Strategy – Develop A Catheter Last Culture

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Place Scribner Shunt- then create a secondary AVF or AVG

Back to the Future ?

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Thanks to Prabir Roy-Chaudhury, MD for making available many of his slides

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Any Questions ?

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Objectives

  • Discuss catheters as a necessary evil
  • Factors promoting catheter utilization
  • Suggest strategies to avoid catheters

23

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Danielle Daley, MBA Executive Director ddaley@nw1.esrd.net Jaya Bhargava, PhD, CPHQ Operations Director jbhargava@nw1.esrd.net Kristin Brickel, RN, MSN, MHA, CNN Quality Improvement Director kbrickel@nw1.esrd.net Brittney Jackson, LMSW, MBA Patient Services Director bjackson@nw1.esrd.net Jenna Vonaa

  • Sr. Program Support Coordinator

jvonaa@nw1.esrd.net Krystle Gonzalez

  • Sr. Data Coordinator

kgonzalez@nw1.esrd.net Heather Camilleri, CCHT Quality Improvement Coordinator hcamilleri@nw1.esrd.net Merari Rosario, MHA Community Outreach Coordinator mrosario@nw1.esrd.net 1952 Whitney Avenue, 2nd Floor, Hamden, CT 06517 Phone: (203) 387-9932 Fax: (203) 389-9902

IPRO ESRD Network of New England (Network 1)

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IPRO ESRD Network of New York (Network 2)

Susan Caponi, RN, BSN, MBA, CPHQ CEO, ESRD Program scaponi@nw2.esrd.net Nicole Howell, BA ITIL v3 Information Management Director nhowell@nw6.esrd.net Carol Lyden, RN, MSN, CNN Director, Quality Improvement clyden@nw2.esrd.net John Cocchieri Data Coordinator, QI jcocchieri@nw2.esrd.net Erin Baumann, LMSW Patient Services Director ebaumann@nw2.esrd.net Laura Wright Administrative Coordinator II lwright@nw2.esrd.net Sharon Lamb Data Coordinator slamb@nw2.esrd.net Jeanine Pilgrim , BS Quality Improvement Coordinator jpilgrim@nw2.esrd.net Anna Bennett Education Coordinator abennett@nw2.esrd.net Emancia Brown, MSW Community Outreach Coordinator ebrown@nw2.esrd.net 1979 Marcus Avenue, Lake Success, NY 11042 Phone: (516) 209-5578 Fax: (516) 326-8929

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909 Aviation Parkway, Suite 300, Morrisville, NC 27560 Phone: (919) 463-4500 Fax: (919) 388-9637

IPRO ESRD Network of the South Atlantic (Network 6)

Shannon Wright, BSW, PMP, ITIL v3 Executive Director swright@nw6.esrd.net Anna Bennet Education Coordinator abennet@nw6.esrd.net Nicole Howell, BA, ITIL v3 Data Manager nhowell@nw6.esrd.net Dansowaa “Dee” Ahima Data Coordinator dahima@nw6.esrd.net Wambui Kungu, BS Quality Improvement Coordinator wkungu@nw6.esrd.net Ariana Lucido, BS Operations Manager alucido@nw6.esrd.net Emily Watson Program Support Coordinator ewatson@nw6.esrd.net Tracey Howard Data Coordinator thoward@nw6.esrd.net Susan Waite, MEd, BSN, ANP, CNN Quality Improvement Coordinator swaite@nw6.esrd.net Melissa Arrington, MSW Patient Services Director marrington@nw6.esrd.net

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Victoria Cash, MBA, BSN, RN Executive Director vcash@nw9.esrd.net Wendy Cable, BA, RN Assistant Director, Information Management wcable@nw9.esrd.net Debbie DeWalt, MSN, BSN, RN Assistant Director, Quality Improvement ddewalt@nw9.esrd.net Andrea Bates, MSW, LISW Patient Services Coordinator abates@nw9.esrd.net Michelle Kaszowski

  • Sr. Program Support Coordinator

mkaszowski@nw9.esrd.net VACANT Data Coordinator TBD Susan Swan-Blohm, BS, OCDT Quality Improvement Coordinator sswan-blohm@nw9.esrd.net Nina Pollard, MPH Community Outreach Coordinator npollard@nw9.esrd.net 3201 Enterprise Parkway, Suite 201, Beachwood, OH 44122 Phone: (216) 593-0001 Fax: (216) 593-0101

IPRO ESRD Network of the Ohio River Valley (Network 9)

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For more information:

IPRO ESRD Program http://esrd.ipro.org

CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY 11042-1002 www.ipro.org

NW1: quality@nw1.esrd.net NW2: qualityimprovement@nw2.esrd.net NW6: info@nw6.esrd.net NW9: quality@nw9.esrd.net