|
|
|
Hemodialysis requires frequent access to the patient's blood stream
(vascular system). Vascular access has been called the "Achilles'
Heel" of hemodialysis care. Hemodialysis vascular access procedures
and associated costs come to $8,000-10,000 per patient per year.
This amount represents approximately 25 percent of total ESRD medical
costs. The most common problems are stenosis (narrowing of graft/blood
vessel), infection, and thrombosis (clotting).
At present, three types of vascular access are predominant: AV
(arteriovenous) fistulas, AV grafts, and catheters. AV fistulas
are surgically created by connecting a patient's own artery and
vein, usually in the forearm. AV fistulas have the lowest rate of
complications, but take from several weeks to several months to
mature, heal, and develop in size. Over time, an AV fistula becomes
large enough to accommodate the needles required for hemodialysis.
AV grafts are also created surgically, but use a synthetic blood
vessel to connect the vein and artery. The needles are inserted
into this synthetic graft. AV grafts require shorter times (if any)
to heal before they can be used, but tend to have more incidents
of stenosis and thrombosis than AV fistulas. Catheters are most
often used as "bridge" devices, used to bridge the time
between from start of dialysis treatments (often an emergency) to
when the patient's AV fistula or AV graft has matured and is ready
for use. Catheters are generally not used as long-term devices as
they tend to have higher rates of infection and thrombosis.
|
|
 |
Hemodialysis
Access Planning, Creation, and Maintenance Coordination - Online training
in June for surgeons, interventionalists, and other renal clinicians from
Fistula First. - June 13 & 19
|
|
Vascular
Access Versus the Effect of Statins on Inflammation and Fibrinolysis in
Renal Dialysis Patients - Article in Press abstract from the Journal
of Vascular Access. - May 3, 2013
|
|
Dyslipidemia
Is Associated With Tunneled-Cuffed Catheter-Related Central Venous Thrombosis
in Hemodialysis Patients: A Retrospective, Multicenter Study - Early
View abstract from Artificial Organs. - May 2, 2013
|
|
Kienböck's
Disease Associated with Radiocephalic Fistula Formation in a Patient with
End-Stage Renal Disease - Early View Abstract of Case Reports from
Hemodialysis International - April 25, 2013
|
|
'Off-the-Shelf'
Artificial Blood Vessels Show Promise - Article from HealthDay. -
April 24, 2013
|
|
Articles in Press
Abstracts from the Journal of Vascular Access - April 18, 2013
• Survival
and Complications of Arteriovenous Fistula Dialysis Access in an Elderly
Population
• Monitoring
Dialysis Arteriovenous Fistulae: It's in Our Hands
|
|
Interventional
Nephrology: When Should You Consider a Graft? - CJASN Express Abstract -
April 18, 2013
|
|
Use
of an Implantable Needle Guide to Access Difficult or Impossible to Cannulate
Arteriovenous Fistulae Using the Buttonhole Technique - Article in
Press abstract from The Journal of Vascular Access. - April 17, 2013
|
|
Vascular
Access in Haemodialysis: Strengthening the Achilles' Heel - Advance
Online Abstract from Nature Reviews Nephrology - April 16, 2013
|
|
Stenting
Dramatically Improves Treatment Access for Dialysis Patients - Press
release from the Society of Interventional Radiology. - April 15,
2013
"After 12-month follow-up, researchers found that two and half times
more patients in the stent graft group were able to continue to use their
dialysis access grafts, than those who were being treated by balloon angioplasty
alone."
|
|
Hand
Ischemia Associated With Dialysis Vascular Access: An Individualized Access
Flow-based Approach to Therapy - Early View abstract from Seminars
in Dialysis. - April 15, 2013
|
|
Bilateral
Pulmonary Emboli Secondary to Indwelling Hemodialysis Reliable Outflow
Catheter - Online First abstract from Vascular and Endovascular Surgery. -
April 8, 2013
|
| |
|
Latest
Scientific Journal Articles on Vascular Access |
|
Latest
issue of the Journal
of Vascular Surgery |
|
The Gold Standard
- A quarterly newsletter from the Fistula First Breakthrough Iniiative (web
site) |
|
Atlas
of Dialysis Vascular Access - 76-slide presentation from Wake Forest
University. - December 2010 |
|
AV
Access information page and Please
be careful with my veins - An information page to be given to
nurses or phlebotomist who are about to start an IV or draw blood on dialysis
patients (1998). All information
from the Nephron Information Center web site. |
|
Buttonhole
Slideshow - Slide presentation by Lynda Ball from the Northwest Renal
Network - June 2010 |
|
Using
the Buttonhole Technique for Your AV Fistula (pdf format
requires Adobe Acrobat reader) from the Northwest Renal Network web
site |
|
Cannulation
of the Arteriovenous Fistula (AVF) video from the Fistula First web
site |
|
Caring
For & Developing Your New Fistula (pdf) from the Northwest Renal
Network web site |
|
'Change
Concepts' from Fistula First
•Routine
CQI review of vascular access
•Timely
referral to nephrologist
•Early
referral to surgeon for "AVF only" evaluation and timely placement
•Surgeon
selection based on best outcomes, willingness, and ability to provide
access services
•Full
range of appropriate surgical approaches to AVF evaluation and placement
•Secondary
AVF placement in patients with AV grafts
•AVF
placement in patients with catheters where indicated
•Cannulation
training for AV fistulas
•Monitoring
and maintenance to ensure adequate access function
•Education
for caregivers and patients
•Outcomes
feedback to guide practice
•Modify
hospital systems to detect CKD and promote AV fistula planning and placement
•Support
patient efforts to live the best possible quality of life through self-management
|
|
Clinical
Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related
Infection: 2009 Update by the Infectious Diseases Society of America
- full-text article from Clinical Infectious Diseases. - July 1, 2009 |
|
Creating
AV Fistulas in All Eligible Hemodialysis Patients from the University
of Oklahoma College of Medicine web site |
|
Dialysis
Audit Tools: Includes pdfs for hemodialysis hand hygiene, catheter
connect/disconnect, exit site care, and AV fistula/graft decannualation
and Dialysis
Checklists: Includes pdfs for catheter connect, catheter disconnect,
exit site care, cannulation, and decannulation from the CDC's Safe Healthcare
Blog about the Dialysis Bloodstream Infection (BSI
web page) Prevention Collaborative
|
|
Video:
Dialysis Patients Speak: a Conversation about the Importance of AV Fistulas
- 12-minute video on YouTube produced in 2005 for the ESRD Network of
New England. - December 13, 2012
|
|
ESRD
National Vascular Access Improvement Initiative (NVAII) - Fistula First
Project from the ESRD Network of Texas, Inc web
site |
|
Fistula
First web site, Fistula
First Data, 2010
Annual Report, and Patient
Section |
|
Fistula
First Inservice Module (pdf format requires Adobe Acrobat reader) from the ESRD Mid-Atlantic Renal Coalition
web site |
|
Fistula
First: Patient Educational Flyer
(pdf) lists pros and cons of a fistula, graft, and catheter |
|
Fistula
First Project news summary from RenalWEB |
|
Frequently
Asked Questions about the ArterioVenous Fistula (pdf) and Fístula
Arteria Venosa En Español (pdf) from the Northwest Renal Network
web site |
|
Guidelines
for the Prevention of Intravascular Catheter Related Infections
from Morbidity and Mortality Weekly Report web
site - August 2002 |
|
Helping
the Patient Make Healthy Fistula Choices - educational Web-EX Series
from The Renal Network, Inc. - June 29, 2009 |
|
Just
the Facts: Vascular Access and Información
esencial: Acceso vascular (pdf format requires Adobe Acrobat Reader) from the Life Options web
site |
|
Keeping
Your Access Uncovered - (2-page pdf) from the Northwest Renal Network |
|
Let's
Talk About Fistulas - 3 minute video from the Fistula First Breakthrough
Iniiative (web site) |
|
The
natural history of autologous fistulas as first-time dialysis access in
the KDOQI era - full text article from the Journal of Vascular Surgery
- February 2008 |
|
Preparing
the Vascular Access for Cannulation (pdf format requires
Adobe Acrobat reader) from the Northwest Renal Network web
site |
|
Prevent
Dangerous Hemodialysis Catheter Disconnections article from FDA's Center
for Medical Devices |
|
Poster:
Protect
Your Access – It's Your Lifeline! 1-page pdf from the Northwest
Renal Network web site
|
|
Protocol
for the Referral and Placement of Permanent Vascular Access (pdf
format requires Adobe Acrobat reader) from the ESRD Network 11
web site |
|
Revised
European Best Practice Guidelines for Hemodialysis - Vascular Access
- guidelines endorsed by the European Renal Association-European Dialysis
and Transplant Association (ERA-EDTA) |
|
Example
Self-Cannulation of Vascular Access Procedure (requires
Microsoft Word™) from the National Vascular Access Improvement
Initiative (NVAII) Tools and Resources Sub-committee |
|
3
Ps for Vascular Access Success - Handbook from The Renal Network, Inc.
and slides
- November 2010 |
|
Vascular
Access quality improvement from The Renal Network (ESRD Network 9/10)
web page |
|
Vascular
Access - A Lifeline for Dialysis - new module at the KidneySchool™. |
|
Vascular
Access Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’
Association |
|
Vascular
Access for Hemodialysis from the NIDDK Publications Online for Kidney
Disease |
|
Vascular
Access for Hemodialysis (pdf) from the Northwest Renal Network web
site |
|
Vascular
Access Patient Education "Electronic Notebook" (pdf
format requires Adobe Acrobat reader) from the ESRD Network # 14 web
site |
|
Venous
Needle Dislodgement - How To Minimize the Risks - (pdf) poster from
the EDTNA/ERCA |
|
Vital
Signs: Central Line--Associated Blood Stream Infections --- United States,
2001, 2008, and 2009 - Article from the CDC's Morbidity and Mortality
Weekly Report. The article mentions the word "dialysis" 42 times.
- March 2011
"The majority of central line--associated blood stream infections
are now occurring outside of ICUs, many outside of hospitals altogether,
especially in outpatient dialysis clinics."
|
| |
