Date of Award
2025
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Yeow Chye Ng
Subject(s)
Hemodialysis, Arterial catheterization, Surgical arteriovenous shunts, Patient education, Patient advocacy
Abstract
International research has shown that central venous catheters (CVCs) perform worse than arteriovenous fistulas (AVFs) in critical outcomes. The National Kidney Dialysis Outcomes Quality Initiative (NKDOQI) guidelines discourage using CVCs for chronic hemodialysis (HD) and recommend that fewer than 10% of patients undergoing HD for over 90 days use CVCs. AVFs are considered superior to other vascular access methods, offering better longevity, lower infection risk, and reduced mortality and morbidity in most patients. However, a large Veterans Affairs Medical Center Dialysis clinic reported that over 50% of patients were dialyzed via CVCs since January 2022. A literature review conducted from 2019 to 2023 highlighted the positive impact of patient navigators on the care of patients with chronic kidney disease and kidney failure. Research indicates that patient navigators improve health outcomes by acting as a liaison between patients and the multidisciplinary team, particularly in obtaining permanent vascular access. Their inclusion has been shown to reduce disparities and enhance outcomes in renal care. Before the implementation of a patient navigator service, there were 102 hemodialysis patients at the facility. Of these, 5 had grafts, leaving 97 eligible for the project. Among the remaining patients, 49 (50.5%) used CVCs, and 48 (49.5%) had AVFs, marking the starting AVF rate at 49.5%. After the patient navigator was introduced, the AVF rate increased to 56.7%, reflecting a 14.6% improvement in the CVC-to-AVF conversion rate. Notably, seven patients transitioned from CVCs to AVFs, while no patients switched from AVFs to CVCs. This demonstrates that the patient navigator intervention was successful in improving vascular access outcomes by increasing the AVF rate.
Recommended Citation
Badejogbin, Aderonke, "Increasing the uptake of arteriovenous fistulas in hemodialysis patients through a patient navigator pathway" (2025). Doctor of Nursing Practice (DNP). 135.
https://louis.uah.edu/uah-dnp/135