SAT-310 ‘R.O.A.R’ TO PROTECT THE VEINS (AND SAVE THE LIVES) OF CHILDREN WITH CHRONIC KIDNEY DISEASE

Abstract

Introduction: Vessel preservation for adult patients with chronic kidney disease (CKD) is the gold standard of care and multiple education programs worldwide actively promote this. Ideally, it should begin before dialysis access is required and should continue post transplantation. Paediatric CKD patients form a unique cohort as they are likely to require multiple episodes of dialysis and several transplants throughout their lifetime. Yet the majority of paediatric nephrology centres around the world do not routinely promote vessel preservation for their patients. We performed an audit of the current phlebotomy practices in the outpatient setting of a large quaternary paediatric nephrology centre over a three-month period. In response to the results of this audit, we created ‘Be a Lion and R.O.A.R.’ - the first vessel preservation education campaign specifically designed for a paediatric population. Methods: Data was collected retrospectively from outpatient nephrology clinics (transplant, dialysis, general nephrology, tubular and nephrotic clinics) between 1st April 2017 and 30th June 2017 using the phlebotomy department’s mandatory logbook. All bloods collected via the outpatient phlebotomy service were of a routine nature in otherwise stable patients. Statistical analysis was performed using descriptive statistics. Results: A total of 686 outpatient phlebotomy episodes were recorded for 472 nephrology patients over the 3-month period from 1st April 2017 to 30th June 2017. The mean age of patients attending outpatient phlebotomy was 10 years, with a range from 1 month to 18.3 years. Overall, 89.1% of these patients had bloods taken from the antecubital fossa (ACF) only. Hand veins were used in 9.7% of patients and as the first attempt in only 7.6% of patients. Foot veins were rarely utilised. More than one attempt was required in 9.9% of patients with 62.7% of these patients having all attempts taken from the ACF only. These trends were echoed across all nephrology patient subgroups, regardless of the clinic they attended. The results of this audit highlight the need for a formal vessel preservation strategy and education awareness program in children with CKD. ‘Be a Lion and R.O.A.R.– Respectfully Object And Re-evaluate’ is a child friendly motto specifically designed to promote vessel preservation in all renal patients. Using quality improvement (QI) methodologies we designed a Driver Diagram plan for vessel preservation. Using a multitier approach, we identified the need for interventions at three key levels: leadership and staff engagement, the creation of a formal hospital policy and most importantly, active promotion of patient and parent education. Implementation and review of these health interventions will occur in stages over the coming months and years. Conclusions: Vessel preservation is not actively practised for paediatric nephrology patients in the outpatient phlebotomy setting. The 'R.O.A.R.' QI template for vessel preservation in children provides a strategic approach for the implementation of this important health intervention. This model is currently in the pilot phase at our quaternary paediatric hospital and if successful, would be applicable to other paediatric nephrology centres worldwide.L20021794772019-07-03 <br />