Quality standard
Quality statement 8: Haemodialysis access – monitoring and maintaining vascular access
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) 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 UK Kidney Association's (formerly the Renal Association) clinical practice guideline on vascular access for haemodialysis.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from vascular access surveillance protocols or assessment tools.
Process
a) Proportion of adults receiving haemodialysis who have an assessment of their vascular access before each access attempt.
Numerator – the number in the denominator who have an assessment of their vascular access before each access attempt.
Denominator – the number of adults receiving haemodialysis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of adults receiving haemodialysis in whom an assessment has identified signs of developing complications with vascular access who have a plan to address their vascular access.
Numerator – the number in the denominator who have a plan to address their vascular access.
Denominator – the number of adults receiving haemodialysis in whom an assessment has identified signs of developing complications with vascular access.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcomes
a) Infection rates.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The UK Renal Registry annual report details renal centre‑specific infection rates per 100 haemodialysis patient-years for methicillin-resistant Staphylococcus aureus bacteraemia, methicillin-sensitive Staphylococcus aureus bacteraemia, Escherichia coli bacteraemia and Clostridium difficile as reported to the UK Health Security Agency for adult patients with end-stage kidney disease who were receiving in-centre haemodialysis or home haemodialysis.
b) Proportion of adults receiving haemodialysis who had rupture of vascular access (fistula and graft).
Numerator – the number in the denominator who had rupture of vascular access (fistula and graft).
Denominator – the number of adults receiving haemodialysis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
c) Proportion of adults receiving haemodialysis who had an intervention for non-functioning or inadequately functioning access.
Numerator – the number in the denominator who had an intervention for non-functioning or inadequately functioning access.
Denominator – the number of adults receiving haemodialysis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
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 by clinical evaluation.
Healthcare professionals (such as nephrologists, renal nurses, vascular access nurses and interventional radiologists) ensure that adults receiving haemodialysis have their vascular access monitored and maintained using systematic assessment by clinical evaluation (inspection of the catheter exits site, or a 'look, feel and listen' approach for fistulas and grafts).
Commissioners ensure that service providers monitor and maintain vascular access using systematic assessment in adults receiving haemodialysis.
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
Vascular access for haemodialysis. The UK Kidney Association (formerly the Renal Association) clinical practice guideline (2023), recommendations 3.12, 3.13, and 5.5
Definitions of terms used in this quality statement
Systematic assessment
Systematic assessment should be based on the UK Kidney Association's (formerly the Renal Association) clinical practice guideline on vascular access for haemodialysis, which highlights the need for appropriate dialysis interventions and systematic clinical observation to detect complications and prevent vascular access failure. This includes clinical evaluation using a basic physical assessment to monitor access and detect dysfunction. [Adapted from the UK Kidney Association's (formerly the Renal Association) clinical practice guideline on vascular access for haemodialysis, sections 3 and 4 and expert opinion]