Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Vanessa Loyd


Dr. Vanessa Loyd

Dr. Tonya Haynes

Jennifer Monk-Beckley, MSN, APRN



Problem: The central venous catheter (CVC) usage rate in a large urban dialysis clinic was 34.5% and the Centers for Medicaid and Medicare Services (CMS) goal is 10.7%. CVC usage is a quality metric monitored by CMS to assess whether dialysis facilities are providing quality services which can impact reimbursement for the clinic. Failure to meet this metric can result in a penalty of up to 2% in reimbursement. The purpose of this quality improvement project was to determine if an interdisciplinary team (IDT) approach to vascular access planning and care influenced the CVC usage rate by 10% in three months.

Methods: An observational descriptive design with a retrospective medical record review was used to evaluate the effectiveness of interventions aimed to decrease CVC utilization rates in a large urban dialysis clinic. This pilot study evaluated an IDT approach to permanent vascular access coordination and was completed between June through August 2021.

Results: Pre implementation of the IDT approach there were (N=57) patients dialyzed through a CVC and post implementation there were (N=59). The monthly CVC usage was compared to CMS performance goal of 10.7%. A Pearson chi-square test was performed ((1)> = 1.775, p = 0.183), and resulted in no statistical significance, but was clinically significant with lowering the CVC usage rates to 29.31% from 34.5%.

Implications for practice: An IDT approach may be adopted over a longer time to assess CVC usage rates before starting hemodialysis by addressing patient barriers (i.e., no insurance, referrals to vascular surgeons).