Jerry Jackson, RMS Lifeline, Birmingham, AL, United States; James Lewis, RMS Lifeline, Birmingham, AL, United States; John Brouillette, RMS Lifeline, Birmingham, AL, United States; and Roman Brantley, RMS Lifeline, Birmingham, AL, United States

Failed hemodialysis vascular access (VA) is the major source of morbidity and cost in the ESRD program. Because the care for such VA is so fragmented this also leads to lower productivity and unsatisfactory patient (pt) outcomes due to the care system. High morbidity in the pt population along with scheduling delays and variable techniques and outcomes were the key reasons the practice developed and implemented a VAC. The key objective of the VAC was to promote an integrative practice model for pt management.

The practice consists of 8 nephrologists who organized and opened the VAC in 1998. The staff includes 2 RNs, 3 RTs, and 4 nephrologists who share the caseload. The lab is in the same building as the primary nephrology office to increase physician efficiency. Pts treated at the VAC include dialysis pts with impending or actual access failure, as well as pre-ESRD pts. 2,004 procedures have been performed to date including: thrombolysis/angioplasty, angioplasty only, fluoroscopy, cuffed catheter placement, cuffed catheter removal, non-cuffed catheter placement and minor surgeries. The table below illustrates the successful outcomes with very low complication rates:

Conclusion: A coordinated vascular care system including a VAC has achieved a reduction in treatment delays; in hospitalizations and missed dialysis treatments; more directed referrals to surgeons, improving access survival and site preservation; earlier access placement efforts now extending to pre-ESRD pts; dialysis units that are more educated about access care and identification of potential problems and pts have a high degree of satisfaction. A nephrology-led VAC improves VA care in dialysis pts.

Disclosure: YES

Disclosure Info: RMS Lifeline is an affiliate of Baxter Healthcare