Quality statement 8: Haemodialysis access – monitoring and maintaining vascular access

Quality statement

Adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment.

Rationale

Maintaining vascular access using systematic assessment (clinical monitoring on each access use and consideration of advanced surveillance) ensures that it works well for as long as possible and so prevents obstruction, infection and other complications such as rupture. Early recognition of a failing access is crucial to inform appropriate intervention, to avoid the need for emergency access and to plan for further access surgery in a timely way. Urgent access‑related complications should be treated by a multidisciplinary team in line with locally agreed protocols and supported by The Renal Association's clinical practice guideline on vascular access for haemodialysis.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment.

Data source: Local data collection.

b) Evidence of a local protocol to ensure that complications of vascular access are recorded and regularly reviewed within the unit.

Data source: Local data collection.

Process

Proportion of adults receiving haemodialysis who have their vascular access monitored and maintained using systematic assessment.

Numerator – the number in the denominator who have a documented plan recording the monitoring and maintenance of their vascular access using systematic assessment.

Denominator – the number of adults receiving haemodialysis.

Data source: Local data collection.

Outcomes

a) Infection rates (by vascular access type: arteriovenous fistula, arteriovenous graft, non‑tunnelled line, tunnelled line).

Data source: Local data collection. The UK Renal Registry details renal centre‑specific infection rates by access type as reported to Public Health England where completion of renal failure and dialysis information is available.

b) Rupture of vascular access (fistula and graft).

Data source: Local data collection.

c) Catheter patency.

Data source: Local data collection.

d) Interventions needed for non‑functioning or inadequately functioning access.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (specialist renal centres) ensure that systems and local protocols are in place so that adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment.

Healthcare professionals ensure that adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment.

Commissioners (NHS England area teams) ensure that service providers monitor and maintain vascular access using systematic assessment in adults receiving haemodialysis.

What the quality statement means for patients, service users and carers

Adults receiving haemodialysis have regular, structured checks of their vascular access (where the dialysis machine is connected to their blood vessels by a needle or tube) to keep it working properly.

Source guidance

The Renal Association (2015) Clinical practice guideline: vascular access for haemodialysis, recommendations 6.3 and 6.5

Definition of terms used in this quality statement

Systematic assessment

Systematic assessment should be based on The Renal Association's Clinical practice guideline: vascular access for haemodialysis, which highlights the need for appropriate dialysis interventions, systematic observation and advanced surveillance to predict and prevent vascular access failure, and ensuring regular review and audit in line with locally agreed protocols by the multidisciplinary team.

[Adapted from The Renal Association's clinical practice guideline on vascular access for haemodialysis and expert opinion]