Ultrasound-guided Cannulation. A Health Economic Consideration

Master's Thesis from the year 2017 in the subject Economy - Health Economics, grade: 1,0, Apollon University of Applied Sciences Bremen (Gesundheitsökonomie), course: Masterstudiengang, language: English, abstract: In February 2016, approximately 100,000 people in Germany were affected by chronic kidney disease. 80,000 people in a dialysis program and 20,000 in post-transplant care. The figures are based on projections of health insurance data. 95 % of the dialysis treatment is carried out in a dialysis facility 3 times a week for 4 to 5 hours. A suitable vessel access/shunt is necessary to carry it through. As a "lifeline" and at the same time "Achilles heel" it influences the quality of dialysis and thus also the quality of life of chronically ill people. The access of first choice is an arterio-venous fistula (AVF), which is punctured 375 times a year during 3 dialysis treatments per week 2 punctures per dialysis treatment in 52 weeks per year. Mispunctures and additional dialysis were not considered. Aim: The work examines the benefits of ultrasound-guided shunt puncture from the point of view of cost units and service providers. The following questions are to be answered: 1. Provides the use of ultrasound-guided shunt puncture for payers and for the in-dividual dialysis unit a concrete monetary benefit? 2. Is the acceptance of the shunt punctures by the patients with the use of ultra-sound technique improved? 3. Is the use of ultrasound technology associated with an improvement in puncture quality and a longer shunt survival? Results: There are only a few studies on the use of ultrasonic controlled shunt puncture. None of the users has yet investigated and documented their benefits in a structured manner. The more than 10 years of experience of the team of the slide analysis facility of the Ev. Stift Koblenz under the leadership of Doctor Morgenstern and Doctor Kurb could be used for this work. The greatest monetary benefit results for the cost objects. Outpatient care and radiolog-ical interventions without inpatient admissions represent considerable savings potential. From the perspective of nephrologists in private practice, additional costs are initially incurred for the acquisition of ultrasound technology and the further training of nursing staff. The introduction of ultrasound-assisted shunt puncture requires organizational and personal adjustments, which must be supported and supported by the medical directors of the dialysis facilities.