Management of vascular access for dialysis: an Italian survey.

Introduction Background. To obtain information on the manageQuality of vascular access determines patients’ wellment of vascular access in Italy. being as well as costs and efficacy of dialysis treatment. Method. Questionnaire sent to all dialysis centres. The Creation of vascular access for dialysis requires intermain questions were: (i) who is in charge of establishing action between different professionals, e.g. vascular vascular access? (ii) How is vascular access monitored? surgeon, radiologist and nephrologist. There are large (iii) To what extent is a continuous quality programme differences between countries in how this goal is impleimplemented? (iv) What proportion of patients are mented. It was the purpose of the present analysis of treated using central venous catheters at the start of a representative sample of Italian dialysis centres to dialysis? (v) What proportion of patients are treated (i) obtain data on how vascular access surgery is using central venous catheters as a permanent access? managed; (ii) to evaluate what procedures are chosen (vi) What is the role of interventional radiology? to establish vascular access; and (iii) to monitor Results. The response rate was 45%. All Italian regions outcome. were represented. In almost 80% of the dialysis centres vascular access is established by the nephrologist. Fistula function is monitored by most nephrologists Methods using a recirculation test, ultrasound and radiological A questionnaire was sent to all Italian dialysis centres 45% imaging. An audit (continuous quality programme) is of which replied (n=250). The following questions were implemented in 20% of the dialysis centres. A high posed: (i) whether vascular access surgery was managed by proportion of patients are submitted for dialysis witha nephrologist or a vascular surgeon? [‘management’ implies out an internal AV fistula (in one quarter of the centres organizing, caring for and creating vascular access; (ii) How more than 40% of the patients). Less than 10% of the graft function was monitored? (iii) Whether an audit was patients are dialysed using central venous catheters as performed, i.e. whether a ‘Continuous Quality Improvement Programme’ has been established? (iv) How frequently a permanent access. Interventional radiology for venous catheters were used as the first access for patients vascular access is used only in few centres. with end-stage renal disease (ESRD)? (v) How frequently Comments. Because of the difficulty of coordinating central venous catheters were used as a permanent access; different professionals, most nephrologists manage vasand (vi) which role interventional radiology played in the cular access by themselves. Fistula function is usually respective centre? The results are shown in Table 1. monitored on a routine basis, but a ‘Continuous Quality Programme’ on established standards and Comments audit of outcome and process indicators is not followed in most centres. Late referral is a main obstacle to Vascular access problems must be arranged quickly. effective planning of renal care, as indicated by the Often it is difficult for the nephrologist to arrange high frequency of temporary access at the beginning collaboration with other specialists, e.g. vascular surof dialysis. On the whole, vascular access is properly geon, radiologist etc. in a short period of time. managed by Italian nephrologists, but monitoring Therefore, he is frequently forced to resolve the performance by audit would be desirable. problem all by himself. This survey reveals that central catheters at the start