Authors (including presenting author) :
Kwok CP(1), Tam SL(1)(2), Lo MW(1), Law PY(1), Chan YWE(1), Wong PN(1)
Affiliation :
(1) Department of Medicine & Geriatrics, Kwong Wah Hospital, (2) Nursing Services Department, Kwong Wah Hospital
Introduction :
The proper function of arteriovenous (AV) access is essential for successful hemodialysis (HD). A well-functioning AV access allows for the early removal of temporary hemodialysis catheters, minimizing associated risks and complications. However, standardized clinical monitoring protocols for AV access—crucial for patient education, ongoing care, and early complication detection—remain lacking. To address this gap, we established a structured AV Access Monitoring Pathway in October 2013. This pathway is designed to support all chronic HD patients with newly created AV access, ensuring consistent evaluation and timely intervention.
It was conducted via continuous educational and monitoring, which included renal nurse clinic (RNC) follow-up scheduled upon hospital discharge, post operation 2 weeks and 4 weeks for education and monitoring. USG assessment was incorporated in week 4 assessment for better AVF monitoring since 2016. Any problems or complications of the AV access identified in renal nurse clinic in first 4 weeks after creation will be referred to nephrologist for early management. Patient will then refer to nephrologist in Ultrasound vascular clinic at 8 weeks after access creation.
With the assistance of Ultrasound technology, timely AV access care, patient education and early detection of complications and management can be facilitated.
Objectives :
To improve vascular access care and monitoring of newly created AV access by a multidisciplinary monitoring clinical pathway, aim at facilitating AV access maturation, early detection and management of complications and enable patient empowerment.
Methodology :
This was a comparative study looking at 2 groups of chronic HD patients, 47 AV access created from 1 October 2011 to 30 September 2013 have been recruited as control group and 75 AV access created between 1 October 2013 and 30 Dec 2022 as study group in KWH.
The clinical records were reviewed retrospectively for retrieval of relevant data. In control group (n=47), there were 26 males and 21 females, 41 native fistulas and 6 AV grafts. While in study group (n=75), there were 37 males and 38 females, 48 native fistulas and 17 AV grafts. In this study, patients who failed their AV access in first 4 weeks since AV access creation and those who created their AV access in private sectors have been excluded from the study. The time to maturation was defined as the time interval between the creation operation and first successful use of the vascular access, and this was compared between the two groups.
A comparative study will be conducted to compare chronic HD patients with newly created AV access with and without the care of new training pathway on time to access maturation defined as the time interval between the creation operation and first successful use of the vascular access
Result & Outcome :
The median time to access maturation was 51±9 days vs 86±11 days (P = 0.033), in the study and control groups respectively, with a substantial reduction in the waiting time of 35 days for a newly created AV access to be ready for use.
There were 178 visits in renal nurse clinic and 98 ultrasound vascular clinic visits in this structured patients’ educational program. During the study period, 21 problematic AVF cases were detected in first 4 week after creation and has referred to nephrologists for early management: 9 cases related to wound problems, 1 related to blocked AVF, 1 related to central vein stenosis, 2 cases related to steal syndrome, 12 cases with different degree of stenosis. 7 cases were finally need to undergone angioplasty.
