Pediatric Fistula Initiative: Reducing Bloodstream Infections in an Outpatient Pediatric Hemodialysis Center

In an effort to reduce the rate of infection in children receiving HD at our institution, we introduced the Pediatric Fistula Initiative, a program to increase creation and use of arteriovenous fistula in children

K. Chotikanatis; N. Suman; M. Backer; B. Paudyal; M. Schoeneman; S. Kohlhoff; M. R. Hammerschlag

2014

Scholarcy highlights

  • The prevalence of end-stage renal disease in children in the United States was 86 per million in 2010
  • Program members participated in monthly meetings that served as a forum for stressing the importance of the use of arteriovenous fistula for HD vascular access, they reported monthly incidence of HD accessrelated infections and access-related complications, and they identified and evaluated candidates for AVF creations
  • The referral candidates for AVF creation were all children in dialysis center who had a weight >20 kg and on chronic hemodialysis via central vascular catheters and who were not on active transplant list
  • Creation of the fistula was preferred to be on the nondominant arm or side contralateral to the CVC and at a time when the patient was free from infection for more than 8 weeks
  • Twenty-four of 26 children had received dialysis treatment at the time the program was introduced in April 2011, 2 of 26 had transplantation before initiating the program, and 7 children were started on HD during the implementation of the program
  • Our study demonstrated that a formal program of implement creation and use of AVFs significantly decreased infection rate and infection-associated complications in children who required prolonged dialysis, in children who started HD at a younger age and had comorbidities preventing transplantation or failed transplantation
  • Implementation of the Pediatric Fistula Initiative significantly decreased the rate of access-related bloodstream infection and prevented associated complications in children undergoing HD in our institution

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