By Day 3 of Week 1 – Walden University NURS-6053 Module 1: Discussion Review of Current Healthcare Issues – Vascular Access Disparities on Dialysis Care Essay
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Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Which social determinant(s) most affects this health issue? Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
Vascular Access Disparities on Dialysis Care Essay
The Impact of Vascular Access Disparities on Dialysis Care
One of the biggest challenges in healthcare today, especially for patients with kidney disease, is vascular access for dialysis. For patients who require hemodialysis, their access type can make a significant difference in their overall health. Ideally, an arteriovenous fistula (AVF) or graft (AVG) should be placed before starting dialysis, but many patients, particularly those from underserved communities, begin treatment with a central venous catheter (CVC) instead. Unfortunately, catheters come with serious risks, including a higher chance of infection, blood clots, and hospitalizations (Allon et al., 2018).
Social Determinants of Health and Vascular Access
It’s easy to assume that vascular access issues are just a medical problem, but in reality, social determinants of health (SDOH) play a major role. Many patients don’t receive early kidney care because of financial barriers, transportation issues, or a lack of awareness about their condition. Research shows that individuals from lower-income backgrounds are significantly more likely to start dialysis with a catheter rather than a fistula or graft, which increases their risk for complications (Pisoni et al., 2018). Additionally, education is a key factor—patients who don’t fully understand their condition and the importance of vascular access may not seek care in time, leading to last-minute catheter placements.
How does this issue affect my work?
As a Clinical Educator RN, I see the consequences of vascular access disparities every day. When a patient starts dialysis with a catheter instead of a fistula or graft, it often leads to frequent hospitalizations due to infections or clotting. I’ve worked with patients who return to the clinic multiple times with bloodstream infections, requiring antibiotics, hospital stays, and sometimes even surgical interventions. This not only impacts patient quality of life but also strains healthcare resources, increasing costs and workload for providers (Ravani et al., 2013).
How is my organization addressing the issue?
Recognizing the serious impact of vascular access complications, my organization has taken several steps to improve outcomes:
Early Patient Education: We’ve expanded pre-dialysis education efforts, ensuring that patients and families understand why AVF placement is important.
Vascular Access Coordinators: Specialists now work closely with nephrologists and surgeons to schedule access procedures before dialysis starts.
Telehealth and Mobile Clinics: To address transportation barriers, we’ve increased telehealth options and set up mobile clinics for patients who struggle to reach appointments (Crews & Novick., 2018).
Community Partnerships: We collaborate with local health programs to identify at-risk patients early and connect them to the right care before they reach kidney failure.
Vascular Access Disparities on Dialysis Care Essay
These efforts have already made a difference—more patients are receiving timely AVF placements, and fewer are starting dialysis with a catheter. However, there’s still work to be done. Reducing health disparities requires continued advocacy, policy changes, and additional resources to ensure every patient has access to optimal vascular care.
Addressing social determinants of health isn’t just about improving clinical outcomes —it’s about improving lives. By tackling these barriers head-on, we can create a healthcare system that gives every patient the best chance for a healthier future.
References
Allon, M., Imrey, P. B., Cheung, A. K., Radeva, M., Alpers, C. E., Beck, G. J., Dember, L. M., Farber, A., Greene, T., Himmelfarb, J., Huber, T. S., Kaufman, J. S., Kusek, J. W., Roy-Chaudhury, P., Robbin, M. L., Vazquez, M. A., Feldman, H. I., & Hemodialysis Fistula Maturation (HFM) Study Group (2018). Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study. American journal of kidney diseases: the official journal of the National Kidney Foundation, 71 (5), 677–689. https://doi.org/10.1053/j.ajkd.2017.10.027 Links to an external site.
Crews, D. C., & Novick, T. K. (2019). Social Determinants of CKD Hotspots. Seminars in nephrology, 39 (3), 256–262. https://doi.org/10.1016/j.semnephrol.2019.02.003 Links to an external site.
Pisoni, R. L., Zepel, L., Fluck, R., Lok, C. E., Kawanishi, H., Süleymanlar, G., Wasse, H., Tentori, F., Zee, J., Li, Y., Schaubel, D., Burke, S., & Robinson, B. (2018). International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). American journal of kidney diseases: the official journal of the National Kidney Foundation, 71 (4), 469–478. https://doi.org/10.1053/j.ajkd.2017.09.012 Links to an external site.
Ravani, P., Palmer, S. C., Oliver, M. J., Quinn, R. R., MacRae, J. M., Tai, D. J., Pannu, N. I., Thomas, C., Hemmelgarn, B. R., Craig, J. C., Manns, B., Tonelli, M., Strippoli, G. F., & James, M. T. (2013). Associations between hemodialysis access type and clinical outcomes: a systematic review. Journal of the American Society of Nephrology: JASN, 24 (3), 465–473. https://doi.org/10.1681/ASN.2012070643 Links to an external site. Vascular Access Disparities on Dialysis Care Essay
