Direct costs of rescue procedures to manage vascular access complications in conventional hemodialysis

de Melo, Ana Cláudia Tavares; Lima, Antônio Fernandes Costa

doi:10.1590/1980-220X-REEUSP-2021-0156

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0156 copy

Direct costs of rescue procedures to manage vascular access complications in conventional hemodialysis^* * Extracted from the thesis “Custos associados ao manejo das complicações de acesso vascular para hemodiálise”, Universidade de São Paulo, Escola de Enfermagem, 2020.

Costos directos de los procedimientos de rescate para manejo de las complicaciones del acceso vascular para hemodiálisis convencional

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To measure the average direct cost of procedures performed by health professionals, in a Dialysis Center, for the management of complications of vascular access for hemodialysis.

Method:

Quantitative, exploratory-descriptive case study type research. The average direct cost was calculated by multiplying the time spent by health professionals by the unit cost of direct labor, adding this to the input costs (materials/ medicines/solutions).

Results:

The following average direct costs were obtained: US$0.72, US$2.00 and US$1.41 for “administration of easy-to-dilute, difficult-to-dilute, and undiluted antibiotics”, respectively; $2.61 for “central venous catheter dressing with topical antibiotic”; $48.05 for “alteplase infusion”; US$183.68 for “insertion of central venous catheter for hemodialysis”; and $1.31 for “arteriovenous fistula puncture”.

Conclusion:

Material and drug costs significantly contributed to the composition of the average total direct cost of most procedures.

DESCRIPTORS
Renal Insufficiency, Chronic; Hemodialysis Units, Hospital; Nephrology Nursing; Catheterization, Central Venous; Arteriovenous Fistula; Costs and Cost Analysis

Type of vascular access rescue procedures for HD	n	total ADC US$	SD ± US$	Minimum and maximum amounts US$
Administration of easy-to-dilute antibiotics	10	0.72	0.09	0.58–0.90
Administration of difficult-to-dilute antibiotics	11	2.00	0.21	1.67–2.31
Administration of undiluted antibiotics	17	1.41	0.08	1.33–1.49
Topical antibiotic dressing at the CVC insertion site	106	2.61	0.79	0.99–4.83
Alteplase infusion for CVC unblocking	30	48.05	0.26	47.43–48.39
Insertion of long-term CVC for HD	11	183.68	4.98	177.54–195.19
AVF puncture	151	1.31	0.27	0.92–2.90
Total observations	336	—	—	——————

Type of vascular access rescue procedures for HD	ADC with personnel US$	ADC with material US$	ADC with drugs US$	ADC with solutions US$	Total ADC US$
Administration of easy-to-dilute antibiotics	0.46	0.19	–	0.07	0.72
Administration of difficult-to-dilute antibiotics	1.28	0.37	–	0.35	2.00
Administration of undiluted antibiotics	0.72	0.37	–	0.32	1.41
Topical antibiotic dressing at the CVC insertion site	2.06	0.47	–	0.08	2.61
Alteplase infusion for CVC unblocking	0.95	0.62	46.31	0.20	48.05
Insertion of long-term CVC for HD	30.17	146.07	6.35	1.09	183.68
AVF puncture	0.69	0.54	0.00	0.08	1.31

Type of vascular access rescue procedures for HD	Amount	%
Administration of easy-to-dilute antibiotics	285	23.1%
Administration of difficult-to-dilute antibiotics	235	19.0%
Administration of undiluted antibiotics	94	7.6%
Topical antibiotic dressing at the CVC insertion site	421	34.2%
Alteplase infusion for CVC unblocking	149	12.1%
Insertion of long-term CVC for HD	6	0.5%
AVF puncture	42	3.5%

Type of vascular access rescue procedures for HD	Number of procedures performed	Total direct cost US$ – %
Administration of easy-to-dilute antibiotics	285	623.45–5.18%
Administration of difficult-to-dilute antibiotics	235	1,277.42–10.62%
Administration of undiluted antibiotics	94	514.04–4.28%
Topical antibiotic dressing at the CVC insertion site	421	1,290.72–10.74%
Alteplase infusion for CVC unblocking	149	7,159.45–59.55%
Insertion of long-term CVC for HD	06	1,102.08–9.17%
AVF puncture	42	55.02–0.46%
Total	1232	12,022.18–100%

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Ana Cláudia Tavares de Melo, Av. Professor Lineu Prestes, n° 2565, Butantã,05508-000 – São Paulo, SP, Brazil, anactm@yahooo.com.br

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Direct costs of rescue procedures to manage vascular access complications in conventional hemodialysis* * Extracted from the thesis “Custos associados ao manejo das complicações de acesso vascular para hemodiálise”, Universidade de São Paulo, Escola de Enfermagem, 2020.

Costos directos de los procedimientos de rescate para manejo de las complicaciones del acceso vascular para hemodiálisis convencional

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Direct costs of rescue procedures to manage vascular access complications in conventional hemodialysis^* * Extracted from the thesis “Custos associados ao manejo das complicações de acesso vascular para hemodiálise”, Universidade de São Paulo, Escola de Enfermagem, 2020.