Sands J, Miranda C L
Renal Consultants of Wyoming Valley, Wilkes-Barre, Pennsylvania 18702, USA.
Clin Nephrol. 1997 Aug;48(2):114-7.
As part of our CQI program, we initiated an effort to see if we could successfully increase the total number of native arterio-venous (AV) fistulas relative to synthetic PTFE grafts in our dialysis population. This was a combined effort of the nephrology and surgery departments. The program emphasized placement of brachial fistulas in elderly patients and diabetics. Permcaths were placed in the internal jugular position to allow adequate time for maturation of fistulas. The percentage of AV fistulas in our total dialysis population increased from 28% (93 of 328) in the base period 1990 through 1992 to 44% (170 of 386) in the period from 1993 through 1995 (p < 0.0001). Initial AV fistula insertions increased from 38% (52 of 137) in 1990-1992 to 71.8% (102 of 142) in the years 1993 through 1995 (p < 0.0001). 86.5% (45 of 52) of initial fistulas placed in 1990-1992 were useable compared to 63.7% (65 of 102) in 1993-1995 (p < 0.01). Patient demographics were unchanged throughout the study. In conclusion, the number and percentage of AV fistulas in our dialysis population was significantly increased through a coordinated CQI initiative. We expect that this will have a positive impact on decreasing future thrombosis rates and decreasing the cost of access management.
作为我们持续质量改进（CQI）项目的一部分，我们开展了一项工作，以确定能否在透析人群中成功增加自体动静脉（AV）内瘘相对于合成聚四氟乙烯（PTFE）移植物的总数。这是肾脏病科和外科共同努力的结果。该项目强调在老年患者和糖尿病患者中放置肱动脉内瘘。将临时中心静脉导管置于颈内静脉位置，以便为内瘘成熟留出足够时间。我们透析人群中AV内瘘的比例从1990年至1992年基期的28%（328例中的93例）增加到1993年至1995年期间的44%（386例中的170例）（p<0.0001）。初始AV内瘘植入率从1990 - 1992年的38%（137例中的52例）增加到1993年至1995年的71.8%（142例中的102例）（p<0.0001）。1990 - 1992年放置的初始内瘘中有86.5%（52例中的45例）可用，而1993 - 1995年为63.7%（102例中的65例）（p<0.01）。在整个研究过程中，患者人口统计学特征没有变化。总之，通过协调的CQI举措，我们透析人群中AV内瘘的数量和比例显著增加。我们预计这将对降低未来血栓形成率和降低通路管理成本产生积极影响。
