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Did stopping ultrasound surveillance during COVID-19 result in an increase of the dialysis access thrombosis rate?

Smith, Lindsay; Allsopp, Karen

Authors

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Lindsay Smith Lindsay6.Smith@uwe.ac.uk
Senior Lecturer in Physiotherapy (Academic Clinical Research)

Karen Allsopp



Abstract

Purpose: The COVID-19 pandemic resulted in cessation and subsequent reduction of routine care including the outpatient ultrasound surveillance of AVF. This un-planned service disruption allowed evaluation of effectiveness of US surveillance in reducing AVF/AVG thrombosis.

Methods: This study was a secondary data analysis of monthly access patency for all in-centre patients receiving haemodialysis using an AVF or AVG over a two-year period (April 2019- March 2021). The study included 298 patients with age, access type, patency and COVID status measured as variables. Thrombosis rates for the 12 months prior to COVID-19 and then during the first 12 months of the pandemic were also measured. Statistical analysis to assess mean and standard deviation for relevant variables was used. A p-value of <0.05 was deemed significant.

Results: At the end of the study an increase in thrombosis rate (%) in the non-surveillance year was observed. (1.20) thrombosis/patient/year in the surveillance group vs (1.68) thrombosis/patient/year in the non-surveillance group). Monthly mean of thrombosed access during surveillance (M= 3.58, 95%Cl 2.19-4.98, SD = 2.193) and non-surveillance (M=4.92, 95% Cl, 3.52-6.31, SD=2.19); t (7148) =2.051, p = 0.038.

Conclusion: Reduction in routine Ultrasound surveillance following the COVID-19 pandemic was associated with a significant increase in access thrombosis rate. Further research is needed to unpick whether the associations seen were directly due to service changes, associated with COVID-19 or other factors during the pandemic. This association was independent of SARS-CoV-2 infection status. Clinical teams should consider alternative service delivery options including out-reach, bedside surveillance to balance risks of access thrombosis versus reducing the risk of nosocomial infection with hospital visits.

Citation

Smith, L., & Allsopp, K. (in press). Did stopping ultrasound surveillance during COVID-19 result in an increase of the dialysis access thrombosis rate?. Journal of Vascular Access,

Journal Article Type Article
Acceptance Date May 19, 2023
Deposit Date May 23, 2023
Journal Journal of Vascular Access
Electronic ISSN 1724-6032
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Keywords Access, Arteriovenous Fistula, Burden, COVID-19, Surveillance, Thrombosis, Ultrasound
Public URL https://uwe-repository.worktribe.com/output/10811760
Publisher URL https://journals.sagepub.com/home/jva