Abstract: TH-PO278
Early Transition From Non-Tunneled to Tunneled Hemodialysis Vascular Access for Vessel Preservation in Critically Ill Patients With AKI
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Sohail, Mohammad Ahsan, Cleveland Clinic, Cleveland, Ohio, United States
- Hanane, Tarik, Cleveland Clinic, Cleveland, Ohio, United States
- Lane, James E., Cleveland Clinic, Cleveland, Ohio, United States
- Vachharajani, Tushar J., Cleveland Clinic, Cleveland, Ohio, United States
Background
Strategies for vessel preservation currently remain focused on patients with advanced CKD to ensure future viable arteriovenous access. Given that AKI requiring kidney replacement therapy (KRT), or AKI-D, occurs in approximately 6-7% of critically ill patients, and that 10–30% of AKI-D survivors remain KRT dependent at hospital discharge, vessel preservation should be considered early in these patients as well. We report our experience of early conversion of non-tunneled dialysis catheters (NTDC) to tunneled dialysis catheters (TDC) in patients in whom KRT was anticipated beyond 7 days, as a potential strategy for vessel preservation in AKI-D patients in the medical intensive care unit (MICU).
Methods
We reviewed MICU patients with AKI-D from 5/2020-4/2021 who had their NTDCs converted early to TDCs within 10 days, based on our collaborative care model involving interventional nephrology and MICU teams. Data on the number of NTDCs placed prior to TDC insertion and time to conversion from NTDC to TDC was collected. The control group included patients who received TDCs between 5/2019-4/2020 prior to the implementation of our care model. Characteristics/outcomes of the two groups were compared using t-tests/chi-square tests and two-tailed P-values <0.05 were considered significant.
Results
380 and 102 critically ill AKI-D patients underwent transition from NTDCs to TDCs prior to and after implementation of our care model respectively. The number of NTDCs placed prior to transition to TDCs was significantly higher (mean±SD [range]: 1.51±0.71 [1-6] vs. 0.95±0.73 [0-3]; p<0.001), and the time to conversion from NTDCs to TDCs was significantly longer (mean ± SD [range]: 11.17±5.32 [2-27] vs. 4.82±3.26 [0-10] days; p<0.001) in patients before vs. after the advent of our care model.
Conclusion
Critically ill patients with AKI-D often remain KRT-dependent past hospital discharge and may eventually progress to ESKD, which merits earlier enactment of vessel preservation strategies. Our collaborative care model was one such initiative which resulted in less frequent central venous trauma with fewer NTDC insertions as well as shorter time to conversion to TDCs. This may not only promote vessel preservation, but also streamline transitions of care and reduce the incidence of CLABSI and catheter dysfunction.