Does cannulation technique impact arteriovenous fistula and graft survival?
|
|
|
- Beryl Maxwell
- 6 years ago
- Views:
Transcription
1 Does cannulation technique impact arteriovenous fistula and graft survival? Maria Teresa Parisotto Director, Nursing Care Management Fresenius Medical Care NephroCare Coordination - Bad Homburg - Germany Stockholm, January 23 rd, 2015 FME Copyright MTP - Does cannulation technique impact... Page 1
2 Maria Teresa Parisotto Present professional position and workplace: Director Nursing Care Management, Fresenius Medical Care Deutschland GmbH, NephroCare Coordination, Bad Homburg Germany Education / Past Experience: Graduated in Nursing in 1974 and in Nursing Care Management in 1976 in Milan, Italy Head Nurse in a Dialysis Unit in Milan, Italy Marketing Director Peritoneal Dialysis, Fresenius Medical Care Italy. Marketing Director Peritoneal Dialysis, Fresenius Medical Care Deutschland GmbH. Summary of main areas of interest and experience: Vascular Access Cannulation and Care Dialysis processes analysis Safety in dialysis Recent pubblications: Gauly A, Parisotto MT et al. Vascular Access Cannulation in Hemodialysis Patients A Survey of Current Practice and its Relation to Dialysis Dose, JVasc Access 2011; 12 (4): Parisotto MT, et al. Cannulation technique influences arteriovenous fistula and graft survival. KI advance online publication 9 April 2014 Daniele Marcelli, Maria Teresa Parisotto, et al. Implementation of a quality and safety checklist for haemodialysis sessions. Clin Kidney J (2015) 0: 1 6 doi: /ckj/sfu145Marketing Director, Co-editor of Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula. Joint EDTNA/ERCA and Fresenius Medical Care project. FME Copyright MTP - Does cannulation technique impact... Page 2
3 Preserving the AVF as the patient lifeline: reduced mortality with the AVF compare to Catheter 1 ANZDATA Register 0.8 Survival AVF Catheter p< Months Polkinghorne et al. J Am Soc Nephrol 15: , 2004 FME Copyright MTP - Does cannulation technique impact... Page 3
4 Vascular Access Major Cause of Hospitalisation DOPPS 100% 80% 60% 40% 20% 0% France Germany Italy Spain UK CV related VA related Infection related Gastrointestinal Rayner et al. Nephrol Dial Transplant 19: , 2004 FME Copyright MTP - Does cannulation technique impact... Page 4
5 Complications Associated to VA Cannulation Thrombosis 16,5% Hemorrage 7,5% Infection 5,5% Aneurysm 4,1% % of VA cannulations Yürügen and Erdogan, J Vasc Access 2001; 2: (Data from Master Thesis at Istanbul University) FME Copyright MTP - Does cannulation technique impact... Page 5
6 Preserving the Vascular Access is our responsibility FME Copyright MTP - Does cannulation technique impact... Page 6
7 Phases of Vascular Access Management VA creation VA surveillance VA assessment and preparation VA cannulation VA monitoring during treatment VA disconnection FME Copyright MTP - Does cannulation technique impact... Page 7
8 Vascular Access Cannulation: Study Design Objective: Snapshot on the current practice of vascular access cannulation Design: International, multi-centre, observational, cross-sectional survey Centres: Dialysis centres of the Fresenius Medical Care network in Europe, Middle East, Africa, participation on voluntary basis Procedures: Anonymous documentation of vascular access and its cannulation once per patient (Patient Questionnaire) at appointed date (April 09) FME Copyright MTP - Does cannulation technique impact... Page 8
9 Vascular Access Cannulation: Inclusion criteria Patients treated with haemodialysis or haemodiafiltration during the week the survey was performed Vascular access via native fistula or graft Double needle haemodialysis No catheter, no single needle haemodialysis FME Copyright MTP - Does cannulation technique impact... Page 9
10 Vascular Access Cannulation: Participating Countries and Centres 10 countries / 171 centres / 10,807 patients 2/41 44/2,097 33/1,729 4/110 + South Africa 4/256 4/766 34/ 31/1,048 3,394 5/496 10/870 (Numbers: Centres/Patients by country) FME Copyright MTP - Does cannulation technique impact... Page 10
11 Results FME Copyright MTP - Does cannulation technique impact... Page 11
12 Type of Vascular Access % Fistula Graft FME Copyright MTP - Does cannulation technique impact... Page 12
13 Location of Fistula 0% 20% 40% 60% 80% 100% Arm Leg Left Right Distal Proximal Missing/Not assessable FME Copyright MTP - Does cannulation technique impact... Page 13
14 Cannulation Techniques Rope ladder: 31.0% Buttonhole: 6.1% Other/ missing: 1.8% 1. Rope ladder technique 2. Area technique 3. Buttonhole technique Area: 61.0% FME Copyright MTP - Does cannulation technique impact... Page 14
15 Needles & Cannulation Procedure 0% 20% 40% 60% 80% 100% Needle type Sharp Blunt Back-eye needle Yes No Needle rotation Yes No Bevel direction Upward Downward First needle Arterial Venous Missing data FME Copyright MTP - Does cannulation technique impact... Page 15
16 Direction of Arterial Needle Retrograde 37% Antegrade 63% FME Copyright MTP - Does cannulation technique impact... Page 16
17 Needle Size 16 G: 33.3% 17 G: 1.7% Others: 1.0% 14 G: 2.4% 15 G: 61.5% FME Copyright MTP - Does cannulation technique impact... Page 17
18 Nurses Experience in Dialysis >2-5 yrs: 19% > 1-2 yrs: 7% > 5 yrs: 66% > > mos: 4% < 6 mos: 4% FME Copyright MTP - Does cannulation technique impact... Page 18
19 Preliminary results Logistic regression on the odds ratio to reach Kt/V > 1.2 Odds ratio 95% confidence interval P-value Gender (male vs. female) <0.001 Post-dialytic body weight (per kg) <0.001 Treatment time (per min) <0.001 Treatment modality (on-line HDF vs. HD) <0.001 Direction of arterial needle (retrograde vs. antegrade) Needle size (vs. 17 G) 16 G < G < G <0.001 Fistula type (graft vs. native arterio-venous fistula) <0.001 Blood flow (vs. < 300 ml/min) < <0.001 > <0.001 Dialyser surface (vs m 2 ) <0.001 > <0.001 FME Copyright MTP - Does cannulation technique impact... Page 19
20 Summary Vascular access management and cannulation are important issues in haemodialysis care. Some variability in cannulation practises exists between countries and centres. Observations of this survey provide a broad basis to further study the relationship between vascular access practices and patient outcomes. The first preliminary analysis already indicates that there is a relationship between vascular access cannulation practices and the probability of reaching an adequate dialysis dose. FME Copyright MTP - Does cannulation technique impact... Page 20
21 Cannulation Technique: Research Cinderella Techniques for AVF cannulation are known to vary from clinic to clinic, mainly because of historical training approaches in the individual settings. Unfortunately the influence of cannulation technique on fistula survival has never been an objective of clinical research. There are several questions never answered: Which needle Gauge? Puncture technique: which one is the best? Bevel up or down? Retrograde or antegrade arterial needle puncture? FME Copyright MTP - Does cannulation technique impact... Page 21
22 Cannulation technique vs VA survival: Aim of the Study The aim of the study was to investigate the impact of needle gauge, cannulation technique, bevel direction, retrograde or antegrade arterial needle direction, blood flow and venous pressure on the survival of the vascular access. FME Copyright MTP - Does cannulation technique impact... Page 22
23 Cannulation technique vs VA survival: Patients and Methods Based on the April 2009 survey conducted in 171 dialysis units located in Europe, Middle East and Africa, a cohort of patients was selected for follow-up to investigate vascular access survival FME Copyright MTP - Does cannulation technique impact... Page 23
24 Cannulation technique vs VA survival: Statistical Analysis Primary outcome in our analysis was the time of the first surgical access intervention resulting in the creation of a new access, where survey date serves as baseline. The observation period was 3 years (from April 2009 till March 2012). To adjust for individual patient differences, the following information was extracted from the clinical database: Patient age and gender, BMI, prevalence of diabetes and the use of ACE inhibitors, platelet anti-aggregants, salicylic acid and anticoagulants. Additionally the median blood flow prescriptions was documented at centre level at the time of the survey. FME Copyright MTP - Does cannulation technique impact... Page 24
25 Cannulation technique vs VA survival: Results #1 Out of the 10,807 patients enrolled for the original survey, access survival data was available for 7,058 (65%) from Portugal, UK, Italy, Turkey, Romania, Slovenia, Poland and Spain. Mean age was years; 38.5% were female; 27.1% were diabetics; 90.6% had a native fistula and 9.4% had a graft. Access location was distal for 51.2% of patients. During the follow-up, 51.1% were treated with anti-aggregants and 2.8% with anti-coagulant. FME Copyright MTP - Does cannulation technique impact... Page 25
26 Cannulation technique vs VA survival: Results #2 Prevalent needle sizes were 15 G and 16 G for 63.7% and 32.2% of the patients, respectively (14 G: 2.7%, 17 G: 1.4%). Cannulation technique was area for 65.8%, rope-ladder for 28.2% and buttonhole for 6% of patients, and the direction of arterial puncture was antegrade for 57.3%. The bevel direction was upward for 70.2% of the patients. The prevalent combination between arterial needle puncturing and bevel direction was antegrade with bevel upward (43.1%) followed by retrograde with bevel downward (27.1%). The proportion of the two other combination, antegrade and retrograde with bevel downward were 14.2% and 15.6% respectively. Median blood flow was ml/min. FME Copyright MTP - Does cannulation technique impact... Page 26
27 Needle size, blood flows and venous pressure levels Parisotto MT et al. (2014). Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int doi: /ki G Needle 16G Needle 15G Needle 17G Needle FME Copyright MTP - Does cannulation technique impact... Page 27
28 KM vascular access survival according to VP Parisotto MT et al. (2014). Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int doi: /ki Vascular Access cumulative survival probability FME Copyright MTP - Does cannulation technique impact... Page 28
29 Cox model with primary outcome vascular survival Parisotto MT et al. (2014). Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int doi: /ki FME Copyright MTP - Does cannulation technique impact... Page 29
30 Cox model with primary outcome vascular survival Parisotto MT et al. (2014). Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int doi: /ki FME Copyright MTP - Does cannulation technique impact... Page 30
31 Cannulation technique vs VA survival: Summary In summary, the study revealed that area cannulation technique, despite being the most commonly used, was inferior to both rope-ladder and buttonhole for the maintenance of Vascular Access functionality. With regard to the effect of needle and bevel direction, the combination of antegrade position of arterial needle with bevel up or down was significantly associated with better access survival than retrograde positioning with bevel down. FME Copyright MTP - Does cannulation technique impact... Page 31
32 Cannulation technique vs VA survival: Summary Results referring to the type and location of access and the technical parameters (i.e. venous pressure) were as follows: There was an increased risk of access failure for graft versus fistula, proximal vs distal location, right arm vs left arm, and the presence of a venous pressure greater than 150 mmhg. The results on venous pressure are worth considering. A venous pressure of mmhg is considered acceptable by the scientific community; the results of this study put these values under discussion. However, further investigations are required to clarify the topic fully. FME Copyright MTP - Does cannulation technique impact... Page 32
33 Discussion: Needle Gauge & Blood Flow the Chicken or Egg dilemma In our study, 17-gauge needle was associated with increased risk of early fistula termination. The same applies for blood flows below 300 mml/min. The question: Is it the smaller needle influencing the fistula survival or the use of smaller needles indicates an already existing fistula malfunction? Is it the low blood flow affecting the fistula survival or an already problematic fistula allows only the use of low blood flow? Future investigation are needed to fully clarify these results. FME Copyright MTP - Does cannulation technique impact... Page 33
34 FME Copyright MTP - Does cannulation technique impact... Page 34
35 Effect of arterial needle rotation and the onset of complications Using as a test of significance the chi-square (P = ), there was evidence that there is a strong association between the rotation of the needle and the probability, increased by 40% (odds ratio 1.4), to develop complications during cannulation. Data analyzed Chi-square Chi-square 11 degree of freedom 1 P value P value summary *** Statistically significant? (alpha<0.05) No Complication Yes Yes Complication Total Needle Rotation No Needle Rotation Yes Total Strength of association Relative Risk % confidence interval 1.0 to 1.0 Odds ratio % confidence interval 1.2 to 1.8 FME Copyright MTP - Does cannulation technique impact... Page 35
36 Effect of bevel direction in the arterial needle position (antegrade/retrograde) Antegrade Puncture Retrograde Puncture Bevel Up Bevel Down Bionic Medizintechnick GmbH FME Copyright MTP - Does cannulation technique impact... Page 36
37 Effect of bevel direction in the Graft - PTFE (intraluminal) FME Copyright MTP - Does cannulation technique impact... Page 37
38 Needle diameter vs blood flow and flow pattern vector FME Copyright MTP - Does cannulation technique impact... Page 38
39 Arterial needle direction Antegrade: with the flow Retrograde: against the flow Both needles antegrade: 1. Easier for nurse to puncture 2. Easier for self-puncturing 3. May be fistula protective FME Copyright MTP - Does cannulation technique impact... Page 39
40 Antegrade puncturing may be fistula protective Increased risk of haematoma formation from retrograde filling Tract closure through flow force by antegrade puncture FME Copyright MTP - Does cannulation technique impact... Page 40
41 Summary and Conclusions 1. Rope-ladder cannulation technique as preferred option and only when there is a limited area for cannulation sites, or for the potential self-care dialysis patients choose buttonhole 2. Arterial needle insertion in the antegrade direction (blood flow direction) and with bevel downward 3. In the case of arterial needle retrograde position, the direction of the bevel should be upward G needles are recommended 5. Blood flow 350 ml/m 6. Venous pressure around 150 mmhg 7. Correct haemostasis 8. Patients education to care for the VA FME Copyright MTP - Does cannulation technique impact... Page 41
42 Caring together Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula Joint project of Fresenius Medical Care and EDTNA/ERCA to achieve enhanced multidisciplinary renal team practice in dialysis and develop a Vascular Access Best Practice Guide 42
43 Caring together Project Objectives Raise awareness of the importance for vascular access management as the patient s lifeline Define vascular access cannulation practices based on clinical evidence to minimize complications Develop a best practice guide for vascular access cannulation and care 43
44 Caring together Project Coordinators Jitka Pancírová (on behalf of EDTNA/ERCA) Maria Teresa Parisotto (on behalf of Fresenius Medical Care) 44
45 Caring together The Project Team Iain Morris Francesco Pelliccia Alberto Garcia Iglesias Jitka Pancirova Frank Laukhuf (consultant) Raffaella Beltrandi Nicola Ward Mihai Preda Cristina Miriunis Theodora Kafkia Ricardo Peralta Iris Romash Joao Fazendeiro Maria Teresa Parisotto 45
46 Caring together Project Timeline Sep 2010 Sep 2011 Jan/Dec 2012 Jan/Dec 2013 Apr 2013 Apr 13/Aug 14 Project launch in Dublin and pre-project Survey Presentation of survey results In Ljubljana Project framework definition, preparation of the observational study protocol, selection of participating countries and centres Data Collection and data analysis Kick-off meeting in Bad Homburg Germany Development of the VA Best Practice Guide 46
47 Caring together Project Kick Off Meeting April 18-19th, 2013, Bad Homburg, Germany 47
48 Caring together The tasks of the authors As Subject Matter Expert define what should be in the Best Practice Guide (in scope, out of scope) Define each topic content Create a comprehensive draft Make sure what is written in the draft is correct Do research to gather data per each topic Use additional literature to confirm or change the original statements 48
49 Caring together What should be covered by the Vascular Access Guide? In Scope Responsibilities of the nurse Assessment of the AVF Hygiene and infection control Cannulation techniques Needle removal and haemostasis Complications: prevention and detection Documentation and reporting Patient education 49
50 Caring together What should be covered by the Vascular Access Guide? Out of Scope Arteriovenous Grafts (AVG) Central Venous Catheters (CVC) Patient self-cannulation Preparation for surgery and immediate post-operative care 50
51 Caring together Best Practice Guide outline #1 1. Preface 2. Executive summary 3. Introduction 4. Background 5. VA for haemodialysis 6. Arteriovenous Fistula 7. Hygiene and infection control 8. Arteriovenous Fistula cannulation 51
52 Caring together Best Practice Guide outline #2 9. Complications of Arteriovenous Fistula (related to the fistula) 10. Arteriovenous Fistula monitoring and evaluation 11. Reporting of Arteriovenous Fistula incidents 12. Patient education for the care of Arteriovenous Fistula 13. From Empiric Evaluation to clinical research evidence 14. Conclusions 15. Appendix 16. Index 52
53 Caring together Project Timeline Sep 2010 Jan/Sep 2011 Jan/Dec 2012 Jan/Dec 2013 Apr 2013 Apr 13/Aug 14 Project launch in Dublin and ore-project Survey Presentation of survey results In Ljubljana Project framework definition, preparation of the observational study protocol, selection of participating countries and centres Data Collection and data analysis Kick-off meeting in Bad Homburg Germany Development of the VA Best Practice Guide Sep 2014 Launch of the VA Best Pratice Guide: EDTNA/ERCA
54 Caring together Vascular Access Guide: The launch! 54
55 Caring together Vascular Access Guide Reading examples Easy to use tables 55
56 Caring together Vascular Access Guide Reading examples Highlighted boxes 56
57 Caring together Vascular Access Guide Reading examples Clear illustrations 57
58 Caring together Special thanks to: Professor Bernard Canaud for writing the Preface! RN Jean Pierre Van Waeleghem RN Victor Moscardó Dr. Frank Laukhuf M.Sc. Volker Schoder Prof. Dr. Daniele Marcelli Dr. Adelheid Gauly Dr. Stefano Stuard for contributing to this best practice guide! Dr. Richard Fluck Dr. Maurizio Gallieni Dr. Otto Arkossy RN Emine Unal RN Natalie Beddows RN Marjelka Trkulja for reviewing this best practice guide! 58
59 Thank you for your attention! 59
Does cannulation technique impact arteriovenous fistula and graft survival? Maria Teresa Parisotto CANNT 2017 Halifax October 20 th, 2017
Does cannulation technique impact arteriovenous fistula and graft survival? Maria Teresa Parisotto CANNT 2017 Halifax October 20 th, 2017 Survival Preserving the AVF as the patient lifeline: reduced mortality
Sichol sooksee,rn. Hemodialysis Unit Rajavej Chiang Mai Hospital
Sichol sooksee,rn. Hemodialysis Unit Rajavej Chiang Mai Hospital Button hole or Ladder?? Vascular Access Cannulation It s a Life Line of Hemodialysis patient Arterio-venous fistula(avf) is the K/DOQI
Arteriovenous fistula cannulation by buttonhole technique using dull needle
Original Article Arteriovenous fistula cannulation by buttonhole technique using dull needle Authors Manuel Carlos Martins de Castro 1 Celina de Fátima e Silva 1 João Marcos Rodrigues de Souza 1 Maria
Preservation of Veins and Timing for Vascular Access
Preservation of Veins and Timing for Vascular Access Vassilis Liakopoulos, MD, PhD Department of Nephrology School of Medicine University of Thessaly Greece Hemodialysis VA A sound long-term dialysis access
Technical and Clinical Barriers to Implementing an Optimal Case Mix of Vascular Access
Technical and Clinical Barriers to Implementing an Optimal Case Mix of Vascular Access Louise Moist Associate Professor Lead Vascular Access Ontario Renal Network Schulich School of Medicine University
Medical Education within NephroCare Dr. Berit Goethel The fourth UEMS conference on CME-CPD Brussels, 24 th November 2018
Medical Education within NephroCare Dr. Berit Goethel The fourth UEMS conference on CME-CPD Brussels, 24 th November 2018 Our vision is to improve Quality of Life & clinical outcomes for our patients Page
Dialysis Initiation and Optimal Vascular Access: Outcomes and Mortality
Dialysis Initiation and Optimal Vascular Access: Outcomes and Mortality Shannon H. Norris, BSN, RN June 6, 2018 Dialysis Initiation and Optimal Vascular Access: Outcomes and Mortality DISCUSSION: End Stage
Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique
Nephrol Dial Transplant (2010) 25: 225 230 doi: 10.1093/ndt/gfp420 Advance Access publication 29 August 2009 Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and
JVA ISSN Hemodialysis vascular access management in the Netherlands. Introduction ORIGINAL ARTICLE
JVA ISSN 1129-7298 J Vasc Access 2015; 16 (Suppl 9): S11-S15 DOI: 10.5301/jva.5000366 ORIGINAL ARTICLE Hemodialysis vascular access management in the Netherlands Jan H.M. Tordoir 1, Magda M. van Loon 1,
Improving AV Fistula and Graft Cannulation Practice
Improving AV Fistula and Graft Cannulation Practice MAGIC: A National KQuIP Project Katie Fielding, MAGIC Lead and Co-Chair BRS VA Senior Clinical Educator Haemodialysis, RDU Derby Chair, Measurement &
Physician Clinical Experiences with FIR Therapy in the UK and Taiwan
ENGLAND 1. Source: Moore I 1, Adam JH, Sweeney D, et al. (2011). Far infrared (FIR) therapy An effective treatment for AV fistula maturation and maintenance. J Am Soc Nephrol 2011; 22: 564A (Poster FR-PO1947).
St George Hospital Renal Department Internal Only
RENAL VASCULAR ACCESS CANNULATION POLICY AND PROCEDURE SUMMARY: A functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG) is paramount in the maintenance of regular and optimal haemodialysis
HAEMODIALYSIS. Types of vascular access used for first haemodialysis 2012 to June 2016
SECTION H VASCULAR ACCESS FOR HAEMODIALYSIS Details of vascular access used for haemodialysis for all hospital and home haemodialysis patients were collected during the SRR census week in May 2016. The
Explorations fonctionnelles des abords vasculaires pour hémodialyse
Explorations fonctionnelles des abords vasculaires pour hémodialyse Frank Le Roy Nephrology Department Actualités Néphrologiques Jean Hamburger Necker, 27 avril 2015 1966 Brescia, Cimino, Appel, Hurwich.
Medical Director/Surgeon as Partners WebEx February 11, 2010
Medical Director/Surgeon as Partners WebEx February 11, 2010 Over 400,000 patients are treated yearly for ESRD in the USA; 60% of these patients receive some form of hemodialysis Despite major advances
BUTTONHOLE CANNULATION
BUTTONHOLE CANNULATION What is a Buttonhole? Technique in which an AV fistula is cannulated in the exact same spot, at the same angle and at the same depth of penetration every time. Benefits Reduction
Selection of Permanent Hemodialysis Vascular Access
Selection of Permanent Hemodialysis Vascular Access TABLE OF CONTENTS 1.0 Scope...1 2.0 Recommendations & Rationale... 2 3.0 References... 3 4.0 Sponsors... 9 5.0 Effective Date... 10 Appendix 1: Key Elements
Hemodiafiltration in Europe : Trends, Practices, Outcomes & Perspectives
Hemodiafiltration in Europe : Trends, Practices, Outcomes & Perspectives Prof. Bernard Canaud Nephrology, Dialysis and Intensive Care Lapeyronie Hospital CHRU Montpellier - France Opening remarks and special
Incident Hemodialysis
The Acute Kidney Injury Group Modifying the Highest Mortality Rate in the Major AKI Adverse Outcome Other than Death: Loss ESRD & Incident Hemodialysis The EVA QI Program Integrated Inpatient Early Vascular
MANITOBA RENAL PROGRAM
SUBJECT Venipuncture of Arteriovenous Fistula/Graft MANITOBA RENAL PROGRAM SECTION CODE 30.20.01 30.20 Vascular Access AUTHORIZATION Professional Advisory Committee, Manitoba Renal Program Nursing Practice
Prevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula Hemodialysis Patients and Its Effect on Hemodialysis Adequacy
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4602-4609 Prevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula Hemodialysis Patients and Its Effect on Hemodialysis
TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA
& TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA 2002-2008 Halima Resić* 1, Enisa Mešić 2 1 Clinic for Hemodialysis, University of Sarajevo Clinics Centre, Bolnička 25, 71000 Sarajevo, Bosnia
Gerald Beathard Annual State of the Art Lecture Innovations in Vascular Access - Have We Moved Forward?
Gerald Beathard Annual State of the Art Lecture Innovations in Vascular Access - Have We Moved Forward? Maurizio Gallieni Nephrology and Dialysis Unit Ospedale S. Carlo Borromeo, ASST Santi Paolo e Carlo,
CATHETER REDUCTION. Angelo N. Makris, M.D. Medical Director Chicago Access Care
CATHETER REDUCTION Angelo N. Makris, M.D. Medical Director Chicago Access Care Objectives Discuss tools/techniques proven to improve AVF rates & decrease catheter rates Implement a change process in your
Introduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents
Introduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents Jesus Contreras, D.O. PGY-4 John Yasmer, D.O. Department of Radiology No Disclosures Objectives Introduce
National Surveillance System for Dialysis Centre and Dialysis Associated Diseases
National Surveillance System for Dialysis Centre and Dialysis Associated Diseases Dr Richard Fluck Consultant Renal Physician & Clinical Director, Royal Derby Hospital UK RA Vascular Access Survey 2005
7/7/2015. Objectives. Pros and Cons of Buttonhole Cannulation
Objectives Pros and Cons of Buttonhole Cannulation Charmaine Lok, MD, FRCPC, MSc University of Toronto Toronto General Hospital To gain an appreciation of the importance of proper vascular access cannulation
Lesson #7: Quality Assessment and Performance Improvement
ESRD Update: Transitioning to New ESRD Conditions for Coverage Student Manual Lesson #7: Quality Assessment and Performance Improvement Learning Objectives At the conclusion of this lesson, you will be
ASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM
ASN DIALYSIS ADVISORY GROUP ASN DIALYSIS CURRICULUM Medical Management of Home Hemodialysis Patients Brent W. Miller, MD Professor of Medicine Washington University School of Medicine Saint Louis, Missouri
MIHÁLY TAPOLYAI, MD, FASN, FACP Associate Professor, Louisiana State University; Shreveport, Louisiana, USA Associate Professor; University of Hawai
MIHÁLY TAPOLYAI, MD, FASN, FACP Associate Professor, Louisiana State University; Shreveport, Louisiana, USA Associate Professor; University of Hawai i Postgraduate Training Program at Chubu Hospital, Okinawa,
AMMAR SERAWAN, MD. Ain Wzain Hospital. April 21, 2012 Vascular Access Study Workshop
AMMAR SERAWAN, MD Ain Wzain Hospital April 21, 2012 Vascular Access Study Workshop 1 Inspection for signs of: - infection (redness, discharge, edema) -aneurysms (may be cannulated using the lateral side
Hemodialysis Fistula Maturation Consortium
Hemodialysis Fistula Maturation Consortium Rationale for Fistula Maturation Study Dialysis Access Consortium AVF study 60% of new AVFs were unusable for dialysis at 4-5 months post surgery No predictors
EFFECT OF ONLINE HAEMODIAFILTRATION ON ALL- CAUSE MORTALITY AND CARDIOVASCULAR OUTCOMES Ercan Ok, Izmir, Turkey
EFFECT OF ONLINE HAEMODIAFILTRATION ON ALL- CAUSE MORTALITY AND CARDIOVASCULAR OUTCOMES Ercan Ok, Izmir, Turkey Chair: Walter H. Hörl, Vienna, Austria Wojciech Zaluska, Lublin, Poland Prof Ercan Ok Division
Cannulating AV Fistula using Buttonhole Technique
Nephrology Directorate Subject: Objective: Prepared by: Cannulating AV Fistula using Buttonhole Technique To enable the safe insertion and removal of needles into arteriovenous fistulae using the buttonhole
Why Can't I Cannulate This Fistula? Fistula Immaturity: The Simple But Critical Steps for a Functioning (Mature) AVF
Why Can t I Cannulate This Access? Steven J. Bander M.D. Adjunct Professor of Nephrology St. Louis University Director, Vascular Access Center, St. Luke s Hospital Saint Louis, MO Why Can't I Cannulate
MANITOBA RENAL PROGRAM
SUBJECT Venipuncture of Arteriovenous Fistula/Graft MANITOBA RENAL PROGRAM SECTION CODE 30.30.01 30.30 Vascular Access AUTHORIZATION Professional Advisory Committee, Manitoba Renal Program Nursing Practice
ASDIN 7th Annual Scientific Meeting
Strategies for Decreasing the Use of Hemodialysis Catheters ASDIN 7 th Annual Scientific Meeting Outline Late referral Primary failure Why Not PD? Summary Micah Chan MD MPH FACP Assistant Professor of
Postoperative AV Fistula Evaluation. Postoperative examination protocol. Postoperative AVF Protocol. Hemodialysis Access Surveillance
Hemodialysis Access Surveillance Postoperative AV Fistula Evaluation Failure of maturation Stenosis Perigraft mass/fluid collection Joseph L. Mills, Sr., M.D. Professor of Surgery Chief, Division of Vascular
Supplementary Online Content
Supplementary Online Content Irish AB, Viecelli AK, Hawley CM, et al; for the Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group.
Vascular a ccess access for Dialysis a surgeon s perspecti e v. some observations
Vascular access for Dialysis a surgeon s perspective e. some observations Age of New Haemodialysis Patients 2005 Australia Number (Total=1957) 0.7% 3% 5% 10% 15% 20% 26% 19% 2% 0-14 15-24 25-34 35-44
Cardiovascular Comorbidity and Late Referral Impact Arteriovenous Fistula Survival: A Prospective Multicenter Study
J Am Soc Nephrol 15: 204 209, 2004 Cardiovascular Comorbidity and Late Referral Impact Arteriovenous Fistula Survival: A Prospective Multicenter Study PIETRO RAVANI,* GIULIANO BRUNORI, SALVATORE MANDOLFO,
ASDIN 8th Annual Scientific Meeting
Fistula First Breakthrough Initiative Fistula First Breakthrough Initiative Marianne Neumann, RN, CNN FFBI Clinical Lead New Orleans, LA February 26, 2012 Initiated in 2003 by CMS, Goals Include: to ensure
Superficialización de la vena basílica. Pierre BOURQUELOT, Paris
Superficialización de la vena basílica. Pierre BOURQUELOT, Paris 1 Basilic Vein Superficialization. Pierre BOURQUELOT, Paris 2 (Upper arm) Basilic Vein 3 Technique 2-stage Basilic Vein Tunnel-Superficialization
Development of Haemodialysis Trigger Tool and Patient Safety index to monitor harm events during haemodialysis treatments
Name /title of project and organisation Development of Haemodialysis Trigger Tool and Patient Safety index to monitor harm events during haemodialysis treatments Derby Teaching Hospitals NHS Foundation
Karen Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital
Karen Mak R.N. (Team Leader) Renal Dialysis Centre Hong Kong Sanatorium & Hospital - Renal Transplantation - Peritoneal Dialysis - Extracorporeal Therapy Extracorporeal Therapy It is the procedure in
Acceptance onto dialysis guidelines: St George Hospital
Acceptance onto dialysis guidelines: St George Hospital The following information is a guideline to support clinicians in decision making regarding acceptance onto dialysis. A review of international guidelines
Vascular Access Care Plans: How Can a Care Plan Really Improve Care and Make Everyone s Job Easier?
Vascular Access Care Plans: How Can a Care Plan Really Improve Care and Make Everyone s Job Easier? Plan the Work Work the Plan What is a plan? A method for achieving an end An orderly arrangement of parts
CLINICAL GUIDELINES SUPPORTING THE USE OF BUTTONHOLE NEEDLING at SaTH NHS Trust
CLINICAL GUIDELINES SUPPORTING THE USE OF BUTTONHOLE NEEDLING at SaTH NHS Trust Lead Clinician: Dr Steve Davies Renal Consultant Division: 1 (Unscheduled Care) Implementation date: 16 th September 2014
Juxta-anastomotic stenoses: angioplasty or surgery (or when/why should we wait)?
Juxta-anastomotic stenoses: angioplasty or surgery (or when/why should we wait)? Richard Shoenfeld MD, FSIR, FAHA The Access Center at West Orange West Orange, New Jersey USA SEDAV 2015 Madrid November
Sid Bhende MD Sentara Vascular Specialists April 28 th Dialysis Access Review: Understanding the Access Options our Patients Face
Sid Bhende MD Sentara Vascular Specialists April 28 th 2018 Dialysis Access Review: Understanding the Access Options our Patients Face Disclosures Dialysis Background Why is it important? Outline National
Haemodiafiltration - the case against. Prof Peter G Kerr Professor/Director of Nephrology Monash Health
Haemodiafiltration - the case against Prof Peter G Kerr Professor/Director of Nephrology Monash Health Know your opposition.. Haemodiafiltration NB: pre or post-dilution What is HDF how is it different
Evaluation of AVF and AVG
Evaluation of AVF and AVG 2013 Nephrology Nursing Symposium Albuquerque Vascular Access Leading cause of hospitalization in the ESRD population Annual cost approaching $1.5 billion (USRDS, 2004) Current
COVERA Vascular Covered Stents in the Management of Dysfunctional AV Access
COVERA Vascular Covered Stents in the Management of Dysfunctional AV Access Bart L. Dolmatch, M.D., FSIR Palo Alto Medical Foundation Mountain View, CA USA This presentation is being made on behalf of
PREPARATION OF FISTULA NEEDLES TO COMMENCE HAEMODIALYSIS VIA AVF OR GRAFT AND REMOVAL OF NEEDLES AT END OF DIALYSIS SESSION
Nephrology Directorate Lower Lane Fazakerly L9 7AL PREPARATION OF FISTULA NEEDLES TO COMMENCE HAEMODIALYSIS VIA AVF OR GRAFT AND REMOVAL OF NEEDLES AT END OF DIALYSIS SESSION A) PREPARATION Wash hands
Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns. DNT 2011 Hunter Valley
Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns DNT 2011 Hunter Valley Approximately 45% of AVF are functional without intervention after creation The procedure rate is 1.45-3.3 procedures/avf
Vascular Access for Haemodialysis. Mike Stephens
Vascular Access for Haemodialysis Mike Stephens Overview Learning Objectives History and development of vascular access Standards in vascular access surgery Types of vascular access Complications Objectives
AJNT. Original Article
. 2012 May;5(2):81-6 Original Article AJNT Reaching Target Hemoglobin Level and Having a Functioning Arteriovenous Fistula Significantly Improve One Year Survival in Twice Weekly Hemodialysis Sarra Elamin
New Zealand. Dialysis and Transplantation Audit
New Zealand Dialysis and Transplantation Audit Report for New Zealand Nephrology Services on behalf of the National Renal Advisory Board Grant Pidgeon Standards and Audit Subcommittee July 2012 Establishment
Present evidence on online hemodiafiltration.
Present evidence on online hemodiafiltration. Peter J. Blankestijn Department of Nephrology, Center Circulatory Health, University Medical Center Utrecht, The Netherlands Outline of presentation Basic
Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York
Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York 4th International Conference on Nephrology & Therapeutics September 14, 2015 Baltimore,
Vascular Access Study Overview and Implementation
Vascular Access Study Overview and Implementation Salim Kabalan, MD Co-Principal Investigator Hafez Elzein, MD, MS Managing Director April 21, 2012 Investigator Meeting & Workshop Introduction Majority
CARE OF YOUR FISTULA
CARE OF YOUR FISTULA 1 . What is a fistula? An arteriovenous fistula, or AVF, is a vessel that is formed by joining a vein to an artery in your arm during an operation to form an accessible blood vessel
Developing a Quality Assurance Performance Improvement (QAPI) Program at Your Dialysis Center Rudolph P. Valentini, M.D. Associate Professor of Pediatrics Director of Dialysis Services Vice Chief of Staff
IN.PACT AV Access IDE Study Full Baseline Data. Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators
IN.PACT AV Access IDE Study Full Baseline Data Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators Disclosures Speaker name: Robert Lookstein, MD... I have the following
CHAPTER 5. Haemodialysis. Kevan Polkinghorne Hannah Dent Aarti Gulyani Kylie Hurst Stephen McDonald
CHAPTER Haemodialysis Kevan Polkinghorne Hannah Dent Aarti Gulyani Kylie Hurst Stephen McDonald STOCK AND FLOW AUSTRALIA The annual stock and flow of HD patients during the period - is shown in Figures.,.
Support Methods for Internal Shunt in Patients with Kidney Dysfunction
Support Methods for Internal Shunt in Patients with Kidney Dysfunction Keiko Shintani Key words : Chronic kidney failure, Arteriovenous fistula, Gripping exercise, Hemodialysis Abstract Two exercise training
End Stage Renal Disease (ESRD) Network Learning and Action Network (LAN) Series: Bloodstream Infection (BSI) Quality Improvement Activity
End Stage Renal Disease (ESRD) Network Learning and Action Network (LAN) Series: Bloodstream Infection (BSI) Quality Improvement Activity October 2, 2018 Note: Computer speakers or headphones are necessary
April 18, Dear Mr. Blum and Dr. Conway:
April 18, 2014 Dear Mr. Blum and Dr. Conway: On behalf of the undersigned patient and health professional organizations, thank you for meeting with us Wednesday, September 18, 2013. Our organizations were
Fistula/Graft Protection. Leslie Dork Renal Medicine Associates
+ Fistula/Graft Protection Leslie Dork Renal Medicine Associates + Disclaimer Renal Medicine Associates employee I have no conflicts of interest. + Access failure Infections Infiltrations Stenoses/Thrombosis
What s on the Horizon in Dialysis Access? Libby Watch, MD, FACS Miami Cardiac & Vascular Institute
What s on the Horizon in Dialysis Access? Libby Watch, MD, FACS Miami Cardiac & Vascular Institute Disclosures No relevant disclosures Employee Advanced Access Care Dialysis Work 5 operating surgeons 3
Safety of arteriovenous fistulae and grafts for continuous renal replacement therapy: The Michigan experience
Hemodialysis International 2018; 22:50 55 Original Article Access Safety of arteriovenous fistulae and grafts for continuous renal replacement therapy: The Michigan experience Anas AL RIFAI, 1,2 Nidhi
UPDATE IN VASCULAR ACCESS Mercedeh Kiaii MD FRCPC Rick Luscombe RN BSN CNeph(C) Elizabeth Lee MD FRCPC
UPDATE IN VASCULAR ACCESS Mercedeh Kiaii MD FRCPC Rick Luscombe RN BSN CNeph(C) Elizabeth Lee MD FRCPC Background Endovascular AVF Outline Data from FLEX and NEAT study SPH data Clinical experience Cannulation
Vascular Access for Patients affected by non Renal Disorders. Eric S Chemla St George s vascular Institute London UK
Vascular Access for Patients affected by non Renal Disorders Eric S Chemla St George s vascular Institute London UK Disclosures Gore Covidien Maquet Proteon Therapeutics INTRODUCTION I First fistula in
The Renal Physicians Association Quality Improvement Registry
In collaboration with CECity The Renal Physicians Association Quality Improvement Registry This registry is approved by CMS as a Qualified Clinical Data Registry (QCDR) for Eligible Professionals and GPRO
IN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006
IN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006 PATIENT IDENTIFICATION [Before completing please read instructions at the bottom of this page and on pages 5 and 6] MAKE
BAPN 2016 Audit of dialysis access and complications in UK children
BAPN 2016 Audit of dialysis access and complications in UK children Version 2, 8 th Dec 2015 Yincent Tse, BAPN audit committee member, yincenttse@nhs.net Introduction For children on dialysis, their access
BLEEDING EMERGENCY. Always apply pressure directly over the bleeding site with your thumb or use an inverted bottle top to localise the pressure
Bleeding between dialysis sessions is very rare and there are almost always warning signs before this happens. Warning signs include:- Infection of the fistula Bulging area, usually with shiny skin and
Prospective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access
Prospective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access Disclosure Speaker name:... I have the following potential conflicts
AV ACESS COMPLICATIONS. Ass. Prof. Dr. Habas
AV ACESS COMPLICATIONS Ass. Prof. Dr. Habas COMPLICATION AVF IS CONSIDERED A MINOR PROCEDURE INCIDENCE OF COMPLICATION- 20-27% MANY A COMPLICATION LEADS TO FAILURE OF FISTULA LOSS OF SITE AND VEIN FOR
Results. Modifiable factors for achieving high-volume HDF
IJAO ISSN 0391-3988 Int J Artif Organs 2015; 38 (5): 244-250 DOI: 10.5301/ijao.5000414 ORIGINAL ARTICLE Modifiable factors associated with achievement of high-volume post-dilution hemodiafiltration: results
Department of Vascular Surgery, Maastricht University, Maastricht - The Netherlands 2
The Journal of Vascular Access 2007; 8: 281-286 ORIGINAL ARTICLE Accessory veins and radial-cephalic arteriovenous fistula non-maturation: a prospective analysis using contrast-enhanced magnetic resonance
METABOLISM AND NUTRITION WITH PD OBESITY. Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle
METABOLISM AND NUTRITION WITH PD OBESITY Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle 1 Body Size in Patients New to Dialysis United States Body Mass Index, kg/m2 33 31
Haemodialysis. The AutoFlow Function for the 5008 Therapy System Optimising the Dialysis Fluid Flow Rate
Haemodialysis The AutoFlow Function for the 5008 Therapy System Optimising the Dialysis Fluid Flow Rate 2 The Dialysis Fluid Flow Rate In current dialysis practice, a dialysis fluid flow rate of either
HD Scanning: Velocities and Volume Flow
HD Scanning: Velocities and Volume Flow Non-Invasive Lab Symposium West Orange, NJ April 27, 2018 Volume Flow Cindy Sturt, MD, FACS, RVT 500,000 Americans on dialysis 20-25% annual mortality 65% 5 year
Links to the following videos are also available online underneath the article abstract.
Supplementary Materials: Links to the following videos are also available online underneath the article abstract. 1. Supplementary Video 1: Itching due to kidney failure A patient s experience (vimeo.com/49458473)
PRINTING PERMITTED BY MEMBERS FOR PERSONAL USE ONLY NOT FOR COMMERCIAL REPRODUCTION
Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Graft This book is an initiative of Maria Teresa Parisotto Director of Nursing Care Care Value Management, Fresenius
Technical Aspects for Treating AV Dialysis Fistulae with the IN.PACT DCB. Andrew Holden Auckland Hospital Auckland, New Zealand
Technical Aspects for Treating AV Dialysis Fistulae with the IN.PACT DCB Andrew Holden Auckland Hospital Auckland, New Zealand LINC 2017 26 th January 2017 Disclosure Speaker name: Andrew Holden I have
Percutaneous and Surgical Treatments
AVG Pseudoaneurysms Percutaneous and Surgical Treatments Marius Florescu M.D. Feb. 2015 ASDIN DEFINITION AVG Pseudoaneurysm Formation Incidence AVG Pseudoaneurysm incidence rate ranges between 2% and 10%
Assisted Peritoneal Dialysis
Assisted Peritoneal Dialysis BC Kidney Days Vancouver, BC Matthew Oliver MD MHS Sunnybrook Health Sciences Centre University of Toronto Oct 18, 2012 Declaration 2 Co-inventor of the Dialysis Measurement
Difference in practical dialysis therapy between East Asia and US/EU
Difference in practical dialysis therapy between East Asia and US/EU Jer-Ming Chang. M.D., Ph.D. 1 Professor, Attending physician, Kaohsiung Medical University Hospital; 2 Secretary General, Taiwan Society
Jimmy Wei Hwa Tan, Surg, MD
Jimmy Wei Hwa Tan, Surg, MD Director, Department of Surgery Chief, Department of Cardiovascular Surgery Tainan An-Nan Municipal Hospital, China Medical University, Taiwan Disclosure I have the following
Effect of Buttonhole Cannulation With a Polycarbonate Peg on In-Center Hemodialysis Fistula Outcomes: A Randomized Controlled Trial
Original Investigation Effect of Buttonhole Cannulation With a Polycarbonate Peg on In-Center Hemodialysis Fistula Outcomes: A Randomized Controlled Trial Emma Vaux, MD, PhD, 1 Jennie King, RN, BSc(Hons),
Introduction. Introduction 2/18/2015 ASDIN Vascular Access complications: High associated morbi-mortality. Worsened quality of life
Introduction Vascular Access complications: Ultrasound Evaluation of the Mature AVF and Process Improvement High associated morbi-mortality Worsened quality of life Up to 25 % hospitalized Jose Ibeas M.D.,
Clinical hemodialysis experience with percutaneous arteriovenous fistulas created using the Ellipsys vascular access system
Hemodialysis International 2019 Original Article Clinical hemodialysis experience with percutaneous arteriovenous fistulas created using the Ellipsys vascular access system Hedia HEBIBI, 1,2,3 Jedjiga
Hemodialysis arteriovenous fistula outcomes in elderly patients: a single centre cohort
ORIGINAL ARTICLE Port J Nephrol Hypert 2018; 32(1): 16-21 Advance Access publication 14 February 2018 Hemodialysis arteriovenous fistula outcomes in elderly patients: a single centre cohort Hugo Ferreira
World Congress of Nephrology, Mexico City
World Congress of Nephrology, Mexico City - 2017 Introduction To study the prevalence and incidence of Hepatitis B and C in a dialysis cohort and analyse factors that cause cross-infection. Methods A total
DESIGNED TO TACKLE RENAL DISEASE IN WALES DRAFT 2 nd STRATEGIC FRAMEWORK for
DESIGNED TO TACKLE RENAL DISEASE IN WALES DRAFT 2 nd STRATEGIC FRAMEWORK for 2008-11 1. Aims, Outcomes and Outputs The National Service Framework Designed to Tackle Renal Disease in Wales sets standards
Assessment, Monitoring, and. Svetlana (Lana) Kacherova, ESRD Network 18, QI Director WebEx session, December 18, 2008
Vascular Access Assessment, Monitoring, and Surveillance Svetlana (Lana) Kacherova, ESRD Network 18, QI Director WebEx session, December 18, 2008 1 Special Acknowledgement for Content Contributions: RMS
Occlusion: A New Technique Antegrade wiring i with retrograde ballooning and stenting
How To Treat Resistant Central Venous Occlusion: A New Technique Antegrade wiring i with retrograde ballooning and stenting Dafsah A Juzar T. Santoso National Heart Center, Harapan Kita, & Medistra Hospital