SCM15: Access Skills for Renal Fellows

Dossabhoy, Neville R.Dr. Neville R. Dossabhoy (ND), from LSU Health School of Medicine-Shreveport and VA Medical Center, Shreveport, Louisiana, discusses his abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Tunneled Dialysis Catheter Removal is a Skill That Can Be Taught to All Nephrology Fellows in Training, with Dr. Kenar Jhaveri, AJKD Blog Editor.

AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?

NRD: Removal of tunneled dialysis catheters (TDC) is usually done in the Intervention suite or at the bedside by interventional nephrologists or radiologists. We wanted to evaluate this skill for the nephrology fellows in training.

This is a retrospective chart review of all TDC removals during the most recent 5-year period performed on an outpatient basis by nephrology fellows under faculty supervision at our academic training center.

We identified 72 TDC removals that met the above criteria. Only 2 possible complications were identified, although only one could be ascribed to the TDC removal procedure itself. TDC removal on an outpatient basis by fellows in training, done under supervision, is successful (99%) and safe in the vast majority of cases. There was no increase in risk of bleeding; even in patients on Aspirin, Plavix or Coumadin, only 1/49 patients (2%) had a minor bleeding complication. We think that this skill can and should be taught to all nephrology fellows. This would expand the scope of practice for “regular” nephrologists, and facilitate patient care.

AJKDblog: Tunneled catheter placement and removal is a skill that is being lost in nephrology training. How do you think we can revitalize those efforts and skills?

NRD: Tunneled catheter removal is a skill that can be easily learned by the fellows, even in fellowship programs that do not incorporate formal Interventional Nephrology training. The procedure is quite straight-forward, and the technique is described in our poster. The faculty teaching this skill does not have to be an Interventionist – as I am not – as long as they have previously received appropriate training themselves.

Crucial to revitalizing this skill is enthusiasm on the part of both fellow and faculty, and an awareness of the advantages it offers. This skill would expand the scope of practice for “regular” nephrologists, for whom it represents a potential source of physician revenue – especially in an era of ever-diminishing reimbursements. It can facilitate patient care by reducing time spent waiting on referral to other services to perform this procedure – thereby avoiding complications like infection in a central line that is no longer being used.

Tunneled catheter placement is a more complicated procedure that needs a minimal number of procedures performed to document competency. It can be taught by faculty who are certified to perform the procedure themselves, which usually happens to be interventional nephrologists or radiologists.

AJKDblog: Where do you and your group go from here?

NRD: We would like to expand this pilot study, by including a larger number of patients and extending the study period. Of particular interest would be the sub-group receiving oral anti-coagulation or anti-platelet agents. It would also be interesting, in the future, to document the outcomes of revitalizing this skill in our fellows – how it changes their practice, patient care and revenue stream. This would likely require a prospective study sometime in the future that is collaborative and involves multiple training sites.

Click here for a full list of SCM15 abstracts of poster presentations.

Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings!

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