Abstract: FR-PO679
Bedside Peritoneal Dialysis Catheter Insertion Program at the University Health Network – An Improvement Initiative to Grow PD Prevalence
Session Information
- Dialysis: Peritoneal Dialysis - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Ibrahim, Ali Z., University of Toronto, Toronto, Ontario, Canada
- McQuillan, Rory F., University of Toronto, Toronto, Ontario, Canada
Background
Peritoneal dialysis (PD) is underutilized in many jurisdictions, despite known societal and individual benefits, cost efficiency, and safety. One identified cause is lack of timely access to PD catheter insertion, which lends itself to quality improvement and innovation.
Methods
At the University Health Network at the University of Toronto, we sought to initiate a nephrologist-led bedside PD catheter insertion program directed at late presenting ESKD patients, beginning in January 2013, with appropriate support from a nursing education and infrastructure perspective. This included the implementation of a “Dialysis Start Unit” for patients needing Intermittent Peritoneal Dialysis while waiting for training with a nursing educator, as well as a dialysis catheter coordinator who was involved in both the bedside and surgical PD insertion programs. Specifically, the program aimed to help grow the PD program, while maintaining literature standards for catheter function, adverse events, and technique survival.
Results
The nephrology division at UHN has been able to create sustainable growth at a rate of 35% in its PD population using a safe, resource conscious, and effective way. This growth has come with no cost by way of patient adverse events or sacrifice of technique survival. Indeed, PD catheter failure rates have been consistently falling with more experience within the program, and within the last 2 years have been well below the accepted literature standards of 25%, at a rate of 5-7%. This is in keeping with available evidence that operator expertise, experience and interest have a large bearing on the success of any insertion technique. The rise in PD population was also accompanied by stability of home hemodialysis (HHD) and in-centre intermittent hemodialysis (IHD) numbers, while continuing to have a sustained rise in PD patient numbers.
Conclusion
Using a well-coordinated multi-disciplinary initiative to insert PD catheters at the bedside, the nephrology division at UHN was able to increase PD prevalence in a safe manner, which can be replicated in a similar context using similar resources and planning