Prospective Analysis of Arteriovenous Access Use in Continuous Renal Replacement Therapy, a Feasibility Project
East Carolina University
Summary
Arteriovenous fistula or graft are the ideal hemodialysis access. Nonetheless the most common access type used for Continuous Renal Replacement Therapy (CRRT) is either a temporary or permanent hemodialysis catheter. Recommendations for the use of catheters to deliver CRRT in end stage kidney disease (ESKD) patients are lacking on data and subjective to anecdotal experiences and expert consensus. The repetitive placement of catheters in ESKD patients have shown to increase the chances of central vascular stenosis which is one of the main risk factors that lead to access failure. Also, the repetitive use of dialysis catheters increases the risk for catheter associated infections. Dedicated studies demonstrating the safety and feasibility of using arteriovenous access (AVA) for CRRT are scarce. No screening criteria or algorithm exists to determine the adequate patient and clinical scenario to use AVA for CRRT. Goals of the study: 1. To develop a standard operating procedure for the use of AVA in CRRT. 2. Evaluate the safety and efficacy of using AVA for CRRT.
Description
This study is a single-center, single-arm, quasi-experimental implementation study incorporating both retrospective and prospective data collection to evaluate the feasibility, safety, and clinical outcomes of using existing arteriovenous access (AVA)-including arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs)-for delivery of continuous renal replacement therapy (CRRT) in critically ill patients. A. Background and Rationale:The current standard of care for CRRT delivery in the intensive care unit (ICU) is the placement of a temporary dialysis catheter (TDC). While effective, tempo…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age 18 years or older * Diagnosis of End-Stage Kidney Disease (ESKD) receiving maintenance chronic hemodialysis * Admission to the Intensive Care Unit (ICU) * Presence of a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG) * Clinical indication for Continuous Renal Replacement Therapy (CRRT) * Score of ≥16 points on the study enrollment screening tool Exclusion Criteria: * Age under 18 years * Arteriovenous access thrombectomy within 30 days prior to study enrollment * Documented prolonged bleeding from arteriovenous access within 30 days prior to st…
Interventions
- OtherCannulation of permanent dialysis access, for the purpose of delivering continuous renal replacement therapy.
Permanent dialysis access, including arteriovenous fistulas or grafts, will be cannulated using standard dialysis needles for the purpose of delivering continuous renal replacement therapy. CRRT via arteriovenous access will only be performed in ICU settings where nursing staff have at least one year of ICU experience and have completed both study-specific training and institutional CRRT training. Dialysis nurses will perform cannulation of the arteriovenous access according to the standardized operating procedure.
Location
- East Carolina University Medical CenterGreenville, North Carolina