ESRD NETWORK 6 2011 ANNUAL REPORT

Number of CathtersPROJECT 2: INCREASING AV FISTULAS THROUGH CATHETER REDUCTIONThe MRB’s long-term vascular access strategy is to addresses overall AV access placementand dialysis adequacy. The ultimate goal is to ensure patients are adequately dialyzed and theAV fistula (AVF) is the preferred access type to accomplish this. Venous catheters areassociated with an increased risk of all-cause and infection-related mortality amonghemodialysis patients. The MRB worked with facilities to reduce long-term catheter use and tomaintain low catheter rates while increasing AVF use. The MRB designed this project toincrease the prevalent AVF rate among hemodialysis patients focusing on facilities with thehighest long-term Central Venous Catheter (CVC) rate in the ESRD Network 6 with a primaryfocus of decreasing catheters while increasing prevalent AVFs.Since catheter reduction has a unique set of root causes, barriers, and solutions, Network 6selected facilities with the highest long-term catheter use rates for intervention to have thegreatest impact on the Network 6 overall AVF rate. Facilities with a prevalent AVF rate below66% in March 2011 and operated by a corporate group of at least 20 facilities were selected ifthey had a prevalent long-term catheter rate greater than 10% in March 2011. Network 6assessed project progress of intensive intervention facilities monthly by collection of: vascularaccess data element, catheter reduction worksheet, updates to action steps.Catheter Reduction Success‣ 733 fewer catheters in use (Figure 19)‣ 452 fewer long-term (90-days) catheters in use (Figure 20)Measure of Catheter Use in Network 6 by Month6,8006,6006,4006,2006,0005,8005,6005,4005,200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumber of Catheters 6,508 6,601 6,532 6,542 6,468 6,386 6,274 6,220 6,014 5,810 5,774 5,775MonthFigure 19. Network 6 2011 Catheter Use Distribution by MonthP a g e | 41