Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Ng HW(1)
Affiliation :
(1)Dept of Surgery , Tuen Mun Hospital
Introduction :
Haemodialysis vascular access is prone to thrombosis no matter an autologous arterial fistula or an artificial graft. From our Renal registry in 2021, there were 1823 patients on haemodialysis and the number trends increasing. Patients, who’re having thrombosed problems in vascular access in NTWC, would be referred to the vascular team for further treatment. Most of the time surgical intervention might not be processed immediately, while vascular access thrombosed was found. These patients were inserted with a temporary HD catheter for effective haemodialysis. However, it brought another problem with catheter related thrombosis risk. And the vascular access usually found thrombosed due to the high severity of occlusion, which increased challenge and complexity for surgical intervention. To avoid complete occlusion, and reduce complexity of the surgical intervention, our vascular team started the post-operation surveillance for patients with intervention history.
Objectives :
The aims of vascular access surveillance are, to monitor patency of vascular access, and detect early thrombosis. Patient may offer early intervention in order to maintain the quality of haemodialysis.
Methodology :
Patients were referred to the surveillance clinic by vascular surgeons, around 1 month after intervention and reassessments will be arranged 5 months later. Ultrasonography is the most efficient way to monitor patency of vascular access. Serval indicators will be measured in target vessels, such as vessels’ diameter, Peak Systolic Velocity, Flow Volume also the format of waveform. Also, detecting abnormality such as thrombosed vessel, hematoma , pseudo-aneurysm are included in the aim of surveillance Our team leading nurse joined Australia institution of Ultrasound’s Vascular Ultrasound course. With placement in the vascular unit at Gold Coast University Hospital for 3 weeks. Ultrasound surveillance performed by our team leading nurse was supervised by vascular surgeons.
Result & Outcome :
Result With a total 232 patients participating in clinical surveillance since 2020. 2 patients had identified problems in native artery. 14 patients had identified inflow or in-stent problems. 19 patients had identified an outflow problem. 11 had both inflow and outflow problems. Total 46 patients (19.8%) offer early intervention. 5 patients (2%) found pseudo-aneurysm which required urgent attention. Conclusion Vascular access surveillance can monitor patency and reduce complexity and difficulty of surgical intervention. And help deliver a professional and proficiency service.
