Initial experience of a nephrologist-operated vascular access center

A nephrology practice in Alabama did not feel in control of vascular access management. Scheduling delays, as well as variable techniques and outcomes , leading to high morbidity and mortality, caused frustration with the exis ting care system for vascular access. Our objective was to develop an integ rative system of vascular access care, involving nephrologists along with t he other caregivers, and to demonstrate an improvement in outcomes. Nephrol ogy Vascular Labs (NVL), a recent RMS-Lifeline acquisition, opened a vascul ar access center (VAC) as an extension of the nephrology practice. Both pre -ESRD and ESRD patients are evaluated and treated in the VAC. Treatment is rendered in a timely fashion, to the benefit of the patients. Nephrologists serve as the interventionists. More than 90% of vascular access problems d etected at dialysis are treated at the VAC. More than 2000 procedures have been performed over 2 years. Procedures carried out include thrombolysis wi th angioplasty, fluoroscopy alone or with angioplasty, placement of cuffed and noncuffed catheters, removal of cuffed catheters, and minor surgeries. Success rates have been high. Minor and major complications have been relat ively low. Referrals to both surgeons and radiologists are shown to emphasi ze the role of the VAC as part of an integrative system of vascular access care. Results of a patient satisfaction survey were excellent. The VAC has fulfilled the vision of creating a seamless integration of care for vascula r access. Hospitalization rate has been reduced and it is suspected that th e global cost of access care is markedly lower than prior to the VAC. Multi ple nephrologists can rotate as the VAC's interventionist and jointly obtai n good outcomes and have little variability among them. Several reasons for using a nephrologists as the interventionist are discussed.