Kidney Week

Abstract: FR-OR054

Vascular Audit Checklist in Home Hemodialysis: A Prospective Cohort Study

Session Information

• Home Hemodialysis
  November 03, 2017 | Location: Room 295, Morial Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Dialysis

• 604 Home and Frequent Dialysis

Authors

• Dhruve, Miten, University Health Network, Toronto, Ontario, Canada

Miten Dhruve, MD



Completed medicine at University of Manitoba followed by Internal Medicine at University of British Columbia. Nephrology fellowship was through the University of Manitoba and finally completed a Home Dialysis fellowship with University of Toronto. Currently doing locums at Michael Garron Hospital in Toronto, Ontario, Canada.

• Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada

Christopher T. Chan,

Background

Vascular access related infections lead to increased morbidity and mortality in the home hemodialysis (HHD) population. We had previously reported that errors made on nurse – administered vascular access audit were associated with higher rate of access-related infection. In the present study, we hypothesize that repeat administration of vascular audit, will result in a decrease in the number of errors performed. Furthermore, increase in errors will augment the future risk of vascular related infection.

Methods

We conducted a prospective cohort study of all HHD patients from 2013 to 2016. Vascular access audits errors were obtained from checklists that were nurse administered and occurred on average every six and a half (0 – 32) months.

Results

370 audits were performed on 122 patients with an average HHD vintage of 6.7 (0.8 – 19.5) years. At baseline the mean number of errors was 1.24 + 1.75. This decreased significantly to mean of 0.33+ 0.49 by 8^th audit. Patients with multiple audits demonstrated a significant decrease in median number of errors (baseline median 1, (0-2) end of study median 0, (0-1) p= 0.01). There was a significant relation between > 2 errors and future risk of infection, p<0.001 (Table 1). The overall infection rate was 0.57 infections per patient year.

Conclusion

Vascular access audits have a significant role to play in identification of errors in HHD population with repeat audits leading to a decrease in the number of errors. There exists a strong relation between 2 or more errors and increased risk of future infection. Vascular audit tool should be utilized in HHD programs to identify patient errors in aspiration of decreasing infection rates.

TABLE 1: Chi Square analysis to assess relation between 2 or more errors and future risk of infection.