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  • Line Sepsis and Vascular Access Quality Improvement Project

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    Esam Aboutaleb
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    This document summarizes a quality improvement project examining reasons for line sepsis in hemodialysis patients without arteriovenous fistula (AVF) access. The project analyzed 34 cases of line sepsis and found that 29% were "crash landers" or new dialysis patients, and 23.5% had not previously seen a vascular access clinic. While 26 patients were known to the clinic, some had immature or failing AVFs. Reasons for lack of AVF included patient refusal, unsuitability, and access issues. The project concluded that early AVF needle use and clarifying timelines for line removal could help reduce line sepsis incidents.

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    line sepsis presentation

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    This document summarizes a quality improvement project examining reasons for line sepsis in hemodialysis patients without arteriovenous fistula (AVF) access. The project analyzed 34 cases of line sepsis and found that 29% were "crash landers" or new dialysis patients, and 23.5% had not previously seen a vascular access clinic. While 26 patients were known to the clinic, some had immature or failing AVFs. Reasons for lack of AVF included patient refusal, unsuitability, and access issues. The project concluded that early AVF needle use and clarifying timelines for line removal could help reduce line sepsis incidents.

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    7 views11 pages

    Line Sepsis and Vascular Access Quality Improvement Project

    Uploaded by

    Esam Aboutaleb
    This document summarizes a quality improvement project examining reasons for line sepsis in hemodialysis patients without arteriovenous fistula (AVF) access. The project analyzed 34 cases of line sepsis and found that 29% were "crash landers" or new dialysis patients, and 23.5% had not previously seen a vascular access clinic. While 26 patients were known to the clinic, some had immature or failing AVFs. Reasons for lack of AVF included patient refusal, unsuitability, and access issues. The project concluded that early AVF needle use and clarifying timelines for line removal could help reduce line sepsis incidents.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 11

    Line sepsis and vascular access

    quality improvement project

    Mr Esam Aboutaleb
    Mr Rajesh Sivaprakasam
    Renal Audit Meeting 07/03/2016
    Objective
    • Determine the reasons for not having/ using
    AVF access in HD patients who had line sepsis

    • Identify if there is a need for a pathway to


    reduce the number of incidents of line sepsis
    in this cohort
    Methods
    • Population: HD patients with confirmed line
    sepsis between November 2013 – September
    2014

    • Data collection: Filemaker and Discussion with


    consultants in charge of care with regards to
    cause of death
    Results
    N = 34

    •29% crash landers

    •23.5%have not seen in VAC before line sepsis


    VAC
    Those known to VAC prior to line
    sepsis
    • N = 26
    • 1 DNA theatre
    • 23.5% had functioning AVF before infection
    (7 ‘immature’ for needling, 1 awaiting second
    stage)
    Reasons for not having AVF’s
    • Refusal often having previous failed AVF
    • Unsuitable candidate (and refusal) - Psych/
    IVDU / ETOH excess
    • Unfit at time of consideration for VAC/ failed
    anaesthetic r/v
    • Poor access options following imaging
    • Crash lander
    Vascular access following line sepsis
    • 23 (68%) seen in VAC/on ward post infection
    • 9 (26%) currently have AVF
    • 11 (32%) have had further recurrent infections
    • 8 (24%) dead (1 was line sepsis related, 1
    unknown)
    Avoidable line sepsis?
    • ? Avoidable (n = 6)
    • 1 should have been referred earlier
    • 1 had working needleble fistula but line still in
    situ
    • 3 needed earlier needleing (?US guided)
    • 1 awaiting ligation of collaterals, recognised
    but did not occur
    • Non avoidable (n = 28)
    Key Points
    1) Patient refusal
    * Previous failed AVF
    * ETOH/ IVDU/ Psychiatric input
    2) Needleing immature fistulas
    * One dialysis nurse at RLH - US guided
    * Scope for training/ practice
    development/assessment of dialysis nurses
    3) When to remove THL
    Challenges
    Conclusions
    • Further research into early needleing of AVF
    • May warrant practice development for dialysis
    nurses – more members of the team able to
    do US guided needleing
    • Further thought into most appropriate time to
    remove THL – combined decision of
    physicians/ dialysis nurse/ patient choice.

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