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Abstract
Background: Central venous catheter (CVC) dependence remains common at haemodialysis initiation in Pakistan despite arteriovenous fistula (AVF) being the guideline-preferred vascular access. We evaluated a multidisciplinary vascular access pathway designed to reduce catheter dependence at a high-volume cardiovascular surgery centre.
Methods: This prospective, single-centre, before-and-after quality improvement study included 464 consecutive patients undergoing AVF creation at the Department of Cardiovascular Surgery, Imran Idrees Teaching Hospital, Sialkot, Pakistan, between 20 February and 30 November 2025. A structured pathway comprising a dedicated coordinator, nephrology and vascular surgery assessment, patient education and counselling, mandatory pre-operative Doppler mapping, and weekly multidisciplinary team discussion was implemented mid-study, dividing the cohort into pre-intervention (n=232) and post-intervention (n=232) phases.
Results: Baseline characteristics were comparable between phases. Referral-to-clinic interval fell from 21.0 to 8.0 days and referral-to-surgery interval from 44.0 to 18.0 days (both p<0.001). Pre-operative Doppler mapping rose from 60.8% to 94.8%. CVC use fell from 74.6% to 43.1%, and catheter-free dialysis achievement nearly doubled, from 27.6% to 53.4% (p<0.001). AVF maturation, cannulation success, and early failure rates were unchanged, while hospital readmission fell from 28.0% to 19.0% (p=0.029).
Conclusion: A structured multidisciplinary vascular access pathway substantially reduced catheter dependence and accelerated referral and surgical timelines without compromising AVF outcomes, supporting its feasibility in resource-limited settings.