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Guidelines on Vascular Access Cannulation and Care
Joint project of EDTNA/ERCA and Fresenius Medical Care to achieve enhanced multidisciplinary renal team practice
in dialysis and establish VA guidelines
Project Coordinators:
• Maria Teresa Parisotto - General and Scientific Coordinator on behalf of Fresenius Medical Care
• Jitka Pancirova - General Coordinator on behalf of EDTNA/ERCA
• Jean Pierre Van Waeleghem - Scientific Coordinator on behalf of EDTNA/ERCA
• Raise awareness for the importance of vascular access management as the “patient’s lifeline”
• Define vascular access cannulation practices based on clinical evidence (six months observational study) to minimize complications
• Develop guidelines for vascular access cannulation and care
Project Objectives:
√ Project Framework Definition
√ Preparation of Observational Study Protocol (VASACC)
Selection of Participating Countries and Centres√
Vascular AccessProject Status
Data Collection (Jan - Jul 2013)√Data Analysis (Aug - Dec 2013)
Development of Vascular Access Guidelines (Jan - Jun 2014)
Launch of Vascular Access Guidelines - EDTNA/ERCA 2014−
Vascular Access Project Status
Data Collection study beginning:
Descriptive parameters – per centre
Number of patients on chronic HD treatmentNumber of nurses and physicians in charge,
Descriptive paramters – per enrolled patient
Age & genderMedical diagnoses, type of vascular access, including locationStatus of AVF creation (primary, secondary, previous complications, etc.)MedicationDialysis prescriptionMeasured dialysis dose Kt/V
Vascular Access Project Status
Data Collection per patient per treatment:
VA - General setting AVF localisation (forearm, elbow, upper arm, other) Needle characteristics (size, back-eye (y/n), sharp vs. blunt) Medication with impact on coagulation VA - Cannulation technique Rope ladder vs. area vs. button hole Antegrade vs. retrograde puncture Distance between needle puncture sites (<3, 3-6, >6 cm) Primary bevel-up vs. bevel-down Needle rotation after insertion (y/n)
Vascular Access Project Status
Outcome parameters:
VA ComplicationsPatency impairment, indicated by
QB drop* <50% of prescribed value Signs and symptoms of fistula thrombosis or manifest occlusion
AVF infection (necessary: evident local signs) Haematoma with swelling and/or induration Numbers of punctures >=4 / session Hospitalisation* Death*
* attributable to AVF (complication)
Vascular Access Project Status
Development of Guideline:
* attributable to AVF (complication)
Project Team Members kick-off meeting: 18.19 of April 2013
Picture
Vascular Access Project Status
Project Team Memebers:
* attributable to AVF (complication)
Team Members (EDTNA/ERCA and FME): Iris Romach, Theodora Kafkia, Raffaella Beltrandi, Joao Fazendeiro,
Ricardo Peralta, Mihai Preda, Alberto Iglesias, Nicola Ward, Iain Morris, Francesco Pelliccia, Cristina Miriunis, Jean Pierre van Waeleghem.
Picture
Vascular Access Project Status
Definition of Guideline Outline:
* attributable to AVF (complication)
Workshop Home work
Pictures
Vascular Access Project Status
Next Steps:
* attributable to AVF (complication)
Literature research Development of Guideline full content Revision of the content Endorsement of VAS Final revision Printing Distribution at the next EDTNA/ERCA conference
Results from the VA Survey 2012• For the third consecutive
year a questionnaire about vascular access assessment was distributed at the Strasbourg Conference 2012 in seven languages.
• A total of 9xxx participants from more than 44 different countries participated in the survey.
Which Country are you from?% of Completed Questionnaires per European Country
OtherSwedwn
LatviaGermany
EstoniaPoland
PortugalLithuania
SerbiaGreece
SpainRomania
0 10 20 30 40 50 6024
6666
88
1014
192021
283232
3638
4040
424343
49
N. of Country 44
How many Years have you been Working in Dialysis?
< 5 years 5 –10 years
10 –15 years
>15 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
11.7%
32.8%37.1%
18.3%
In which setting are you working?
43.7%
56.3%
Public hospital Private centre
Which needle do you remove first?
82.0%
18.0%
Arterial needle Venous needle
How do you perform haemostasis after removing the needle?
Applying pressure using one finger on
the gauze
Applying pressure using two fingers on
the gauze
Applying pressure using a
venepuncture site clamp
14.5%
70.6%
14.9%
Are you in favour of asking for patient’s help, by applying
pressure during haemostasis?
87.5%
12.5%
Yes No
Multiple answers were possible
Depending on the characteristics of the patient, on average how long does the haemostasis of a
puncture site take?
Less than 5 minutes
5 to 10 minutes More than 10 minutes
27.6%
67.3%
6.3%
In your opinion, should vascular access care be included in a patients training and education programme?
Yes No
87.0%
13.0%
Is there currently a vascular access training programme for patients in your centre?
Yes No
69.6%
30.4%
In your opinion is the current patient’s training and education programme for vascular access
sufficient?
Yes No
77.5%
22.5%
In your opinion who should be responsible for organising a
training and education programme?
Nurses Nephrologists
66.3%
33.7%
Please rank the following topics on a scale of 1 to 6 according to
importance when teaching a patient about vascular access. (1 for most important, 6 for the least important)
Presence of thrill (patency)
Bleeding management
Early detection of presence of
oedema or haematoma
Care of haematoma
Vascular ac-cess hygiene
How to help the nurse during haemostasis
22.7% 20.2%
3.0% 1.9%
36.0%
16.3%
On a regular basis, do you currently use a vascular access monitoring tool in your clinic?
Yes No
50.8%
49.2%
Who is the professional in charge of organising the
vascular access monitoring programme on regular basis?
Nurses Nephrologists Vascular Surgeons
75.6%
18.5%5.8%
VA Survey 2012 - Conclusion
• 43.7% of participants work in public hospitals• The first needle removed is the arterial one (82%)• 77.5% of the respondents consider the current patient’s
training and education programme for vascular access sufficient
• For 75.6% of the respondents, the professional in charge of organising the vascular access monitoring is the nurse, followed by the nephrologist with 18.5% and vascular access surgeon with 5.8% .
Thank you !Vielen Dank !Merci beaucoup !¡Muchas gracias ! Obrigado !Grazie Mille !Mulţumesc !Děkujeme !Dziekuje !Teşekkür Ederim !Sagolun !Hvala !Köszönöm !