Outcomes from our model for a nurse-led vascular renal access surveillance clinic

Background: A patent arteriovenous fistula (AVF) with adequate flow is essential for performing successful hemodialysis. However, the literature currently reports 1-year patency rates of 69%-74%. Surveillance of AVFs has been proposed to prevent failure of fistulas with the associated morbidity and mortality. We implemented a renal access surveillance clinic with the aims of detecting stenoses and arranging treatment to avoid underdialysis and thrombosis of AVFs. Methods: The nurse-led vascular renal access surveillance clinic (VRAC) of the Royal Brisbane and Women's Hospital was created in 2015. The surveillance program is run by a full-time vascular clinical nurse with experience in renal access. Over the 3-year period of 2015-2017, 1006 patients were in the surveillance program. We compared the rates of intervention on fistulas and the incidence of thrombosed fistula in the 5 years preceding the initiation of our VRAC surveillance program, with the 3 years after it was commenced. Results: Our results show that our rates of intervention on threatened fistulas have increased since the program was established, and that the percentage of thrombosed fistulas has remained stable. Allowing this early triage has expedited management and freed more outpatient clinic time. Conclusion: We have compared outcomes before and after implementation of a nurse-led dialysis access surveillance program and have found that the percentage of thrombosed fistulas has remained stable as the rates of intervention have increased for threatened fistulas.