Who are we? Catchment area of approx 1.5 m people in the Lancashire & South Cumbria region Hub unit at Preston includes: 28 station dx unit 23 bedded ward & 3 acute dx bay 6 satellite units Home training unit @ Chorley District Hosp In 2018 between 550 – 570 Hdx pts/month 129 new pts required HD throughout the yr. Vascular surgeons create AVF in 2 centres
Where are we now • 1 st vascular access renal consultant appointed Jan 17 • QI programme commenced summer 2017 at RPH • Timeframes for simple & complex pathways • USS & consented at surgical appt • Venogram criteria • Dedicated fistula formation theatre list • Nurse Led Clinic • MDT • Fistula rates • Cannulation Technique • Surveillance
Challenges • IT system installed 1986 • Conflicting interests of Trust with MAGIC timeframes • Implementing MAGIC on the hub unit • Reducing the no. of aneurysms
What am I proud of? Nurse Led Clinic Data from Oct 2017- April 18 Types of Patient seen in Nurse Complications in <2 weeks Led Clinic (n=143) Post-op Surveillance (n=85) Failed fistula <2 wks post op Tx Pt 28% Infected 31% 35% 44% HHDX Pt 6% No surgical ICHD Pt f/u 17% 19% 10% Unplanned 10% No problems ICHD/HHD
To Share – my referrals to IRDU from 2014 - 18 Other 18 DNA 5 Patient Refused 5 New Needle Sites 7 Surveillance Scan 8 Flow Rates 13 NAD 20 RIP before Appointment 11 Unable to Salvage 33 Referred to Vascular Surgeon 62.7% of all referrals 34 angioplastied or salvaged Salvaged 33 Angioplasty 226 0 50 100 150 200 250 No of Patients
Thank You Sp Renal Vascular Access Nurse Kathleen Pegg Lancs Teaching Hospital NHS Foundation Trust Royal Preston Hospital kathleenpegg@lthtr.nhs.uk
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