10 STRATEGIC POINTS TABLE

10 STRATEGIC POINTS Comments /

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Broad topic Area Central Venous Catheters (CVC) is only to be
used temporarily. Arteriovenous Fistulas are
the Dialysis access of choice or Arteriovenous
graft. Some patients that start dialysis, which is
a life sustaining treatment, start with a CVC.
Once they are identified we need a system to
get the access converted to AVF/AVG and
removal of CVC as soon as possible. This project
is to determine if it is possible to decrease CVC
use in dialysis patients by using a teamed based
systematic approach to get CVCs removed as
soon as possible. Some patients may not be able
to convert to AVF/AVG. The team-based
approach is a collaboration of care between
internal and external teams to get optimal
dialysis access placement for patients in order
to decrease CVC rate.
Literature A) BACKGROUND: Placing a well-functioning
Review dialysis access is essential in performing
successful dialysis. Ideal access placement is
arteriovenous fistula (AVF) first (AJKD, 2019).
If patient starts with CVC, the need to have it
converted or removed as soon as possible is
essential. The National Kidney Foundation
started national initiatives for the dialysis
communities to follow and achieve by following
guidelines to reach below a certain percentage
of patients with CVCs (NKF, 2014).
Collaborated health care is the approach being
used in this project. Team-based approach will
be utilized and monitored to collect data to
determine the effect on the reeducation of CVC
rate
B) THEORIES/MODELS: One theory will work
when dealing with the situation of decreasing
CVC rates in dialysis patients. Kotter’s Change
Theory this theory will assist in developing,
instituting, and sustaining change in the care of
dialysis patients (Butts, 2018).
C) ARTICLES KEY THEME: Main themes during
 the literature review is team-based health care,
health care collaboration (Porter et al., 2015),
removing CVCs as soon as possible, decreasing
the CVC rates, and AVF first initiative (KDOQI,
2006). Subthemes include lowering
complications, earlier referral for access
placement, better adequacy of dialysis, and
educating patients to have informed decisions
of the access type to choose (Santoro et al.,
2014).
SUMMARY: While CVCs are useful for urgent
start dialysis, compared to an AVF the
complications are much higher. Reducing CVC
rates in a timelier manner, results include
better healthcare outcomes increasing health
care quality among this population (Guerraoui,
2018).
Problem A major problem amongst dialysis patients
Statement either current or newly starting is central
venous catheter (CVC) placements for dialysis.
A CVC has the highest rate of infection. They’re
only to be used as temporary accesses. Placing
a well-functioning dialysis access is essential in
performing successful dialysis.
Clinical PICOT In the end stage renal disease on dialysis
Question population ages ranging from 30s and older,
would implementation of a team-based
systematic approach help remove CVCs as soon
as possible with referral to surgery in order to
get a more appropriate access placed,
compared with the current process of removal
and exchange to preferred access, affect the
CVC rate and achieve the goal of less than 10%
determined by Kidney Disease Outcomes
Initiative Quality (KDOQI), within 1 month
period?
Sample Dialysis patients from one dialysis unit located
in Southern California, which contains
approximately 210 patients, but this project
will be concentrating on the patients with CVCs,
which is approximately 37. The CVC rate is a
variable number depending on the
circumstances through the month. Inclusion
will be all patients with a CVC for an access and
 exclusion will be patients on unit > 6 months.
Define Variables Independent variable: Team-based
systematic approach to CVC removals
Dependent Variable: Decreased CVC rate
Methodology The data from this project is used to determine
and Design the relationship between variables to explain
why or why not something happens. It is
essential in a quantitative research project the
researcher explains in detail what the study is
trying to determine, how data was collected,
and how it was analyzed. This project will be
using quantitative/quasi-experimental method
and design to show in numerical data if the
process implemented decreases the CVC rate
among the patents in this one dialysis unit
where project is being conducted.
Purpose The purpose of this quantitative project is to
statement increase the quality of dialysis for the dialysis
patients. This will ensure dialysis patients have
better healthcare outcomes. Another purpose is
to decrease the complications that can occur
from having inadequate access for dialysis.
Data Collection Weekly meetings, maturation logs, CVC
approach tracking log and other excel reports in order to
collect the data for analysis of successfulness of
the study. Data bases will be used from dialysis
unit to collect the patients with CVCs. Names
will be generated first, but only initials will be
used which are not considered PHI and a non-
specific number will be assigned. This coding
system will be developed so unauthorized
people do not have access to PHI protecting
HIPPA. Consents will not be needed for patients
related to not having direct contact with pt.
Waiver has been filled out for GCU. Consents
will not be needed by employees, because the
tasks they will be performing is in their job
description and not out of their normal tasks.
Data Analysis Descriptive statistics will summarize data to
determine if the new catheter removal protocol
decreases CVC rates by increasing CVC removal
to reach a conclusion if the hypothesis is
answered.
Inferential statistics can also be used to present
generalizations regarding the new catheter
removal protocol and the success rate of
decreasing CVC rates among the participants.