Hemodialysis
Conditions
Keywords
central venous catheter, arteriovenous fistula, hemodialysis, vascular access, dialysis
Brief summary
To determine if a protocolized approach to converting hemodialysis central venous catheters (CVC) to arteriovenous fistulae will improve rates of functioning AVF and decrease CVC use.
Detailed description
In order to receive dialysis, patients require repeated access to their bloodstream. This access can be either via a central venous catheter (CVC) or a surgically created arteriovenous fistula (AVF) or graft (AVG). This is a pilot randomized control trial of prevalent hemodialysis patients with a central venous catheter (CVC), to determine if a systematic approach using an algorithm protocol to convert the CVC to an AVF (arteriovenous fistula) will improve rates of functioning AVF and decrease CVC use. The algorithm (intervention group) will be compared to current practice (control group), a non-standardized approach at the discretion of the caring nephrologist and/or surgeon.
Interventions
OTHERProtocolized approach to convert dialysis catheter to fistula
This group will be assigned an algorithm protocol in efforts to convert the central venous catheter to an arteriovenous fistula. A case manager will be assigned to follow these patients and implement the protocol
Sponsors
Health Sciences Centre Foundation, Manitoba
Dr. Lisa Miller
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* \> 18 years of age * Dialyzing with a CVC * Receiving hemodialysis three times weekly for \> 3 months
Exclusion criteria
* Awaiting peritoneal dialysis catheter insertion * Scheduled living donor transplant * Transient patients from out of province * Expected transfer to satellite dialysis unit within 6 months * Surgical plan for AVF (i.e. scheduled date) * Documented lack of suitable vasculature for AVF * Refusing AVF
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The proportion of patients using a CVC in a prevalent hemodialysis population after the implementation of an algorithm protocol to convert the CVC to an AVF compared with patients who received current standard care. | 9 months |
Secondary
| Measure | Time frame |
|---|---|
| The proportion of patients with a functioning AVF after the implementation of an algorithm protocol to convert the CVC to an AVF compared with patients who received current standard care. | 9 months |
| Proportion of patients with a maturing AVF | 9 months |
| Primary fistula failure rate | 9 months |
| Incidence of AVF salvage procedures, including balloon angioplasty and accessory vein ligation, within 9 months of AVF creation | 9 months |
Countries
Canada
Outcome results
None listed