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Date of Graduation

8-2004

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Robert P. Rosenow, PharmD, OD

Abstract

Context Hemodialysis patients require a vascular access (VA) for blood to be removed from and returned to the body. Types of accesses include the arteriovenous (A V) fistula, the polytetrafluoroethylene (PTFE) graft, and the central venous catheter. Presence of a VA can lead to many adverse events such as infection, expensive hospital surgeries and procedures, and even death. Previous studies have shown that AV fistulae have been correlated with . better patient outcomes than the PTFE grafts and catheters.

Objective This study investigates the differences in outcomes between the different types of dialysis vascular accesses and what demographic, comorbid, and surgical factors contribute to the choice of one type of access over another.

Design This is a retrospective chart review of patients between January 1997 and July 1, 2004.

Setting The study took place at Oregon Health and Science University (OHSU), a large university hospital. Patients or other Participants The subjects were adult OHSU hemodialysis patients who had their primary (first) permanent access placed between January 1997 and July 1, 2004.

Main Outcome Measure(s) Retrospective data was collected regarding age, race, ethnicity, comorbidities, surgeon, timing of VA placement, VA complications, and VA interventional procedures.

Results Males, younger patients, and. whites were more likely to receive A VFs. While our surgeons were meeting national guidelines for primary AVF placement, a significant number of AVFs had primary non-function caused by stenosis, leading to thrombosis of the access before use. Duplex scans were performed on the majority of patients, but the scanning did not appear to be predictive of an access's success. Even though most OHSU VA patients had received nephrology care prior to placement of their access, 74% initiated HD with a catheter. Time to intervention was similar for AVF and AVG patients, though the number of patients receiving interventions was much higher for AVGs. Time to failure was also similar among the two groups, but blacks, obese patients, current smokers, and those with a history of peripheral bypass were more likely to experience an access failure.

Conclusions A vascular access tracking tool, a vascular access liaison, and studies in the areas of duplex scanning, treatment of stenosis, and efficacy of the Cimino fistula could be further areas of investigation and improvement in outcomes for OHSU.

Comments

The digital version of this project is currently unavailable to off-campus users; however, it may be requested via interlibrary loan by eligible borrowers from Pacific University Library. Pacific University Library is a free lender. (Library Use: NL)

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