Venous Access in Apheresis. Daniel Putensen, Apheresis Nurse

Size: px
Start display at page:

Download "Venous Access in Apheresis. Daniel Putensen, Apheresis Nurse"

Transcription

1 Venous Access in Apheresis Daniel Putensen, Apheresis Nurse

2 Why is Vascular Access so important? Henrikson et al. Adverse events in apheresis: An update of the WAA registry data.transfus Apher Sci. 2016; 54: 2-15

3 Vascular Access options for Apheresis PERIPHERAL CENTRAL AV Fistula/Graft Peripheral cannulation Non- Tunneled CVC Tunneled CVC Port single/double USG-PIVA Via one arm Via artery

4 Vascular Access devices 4

5 Central venous access sites

6 CVC position

7 Peripheral venous access sites

8 Ultrasound visualisation of peripheral cannula

9 Advantage / disadvantage of VADs ACCESS DEVICE ADVANTAGE DISADVANTAGE Peripheral access Peripheral access using an ultrasound Central venous access Arteriovenous fistula / graft Quick bedside insertion Low complication rates Cheap >90% patients have adequate veins on US Avoids CVC insertions High inlet flow rates Can stay in situ permanently (i.e., Ports) Can provide permanent and effective vascular access Difficult in patients with no veins Needs patient s cooperation Limited inlet flow rates Requires a new skill-set Expensive equipment More severe complications Requires planning - consent, IR slot, CVC team, etc. Requires surgery Requires staff training / input from renal team

10 Complications Central VAD Pneumothorax Haemothorax Air embolism Venous thrombosis Pinch off syndrome Infection Artery / nerve damage Etc. Peripheral VAD Infection Phlebitis Infiltration Artery / nerve damage Dislocation Stenosis Parienti JJ, Mongardon N, Megarbane B, et. al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373: Nuss R, MD, Cole L, Le T, MD, Orsini E, Harned E. Pinch-Off Syndrome in Patients With Sickle Cell Disease Receiving Erythrocytapheresis. Pediatr Blood Cancer Available from: DOI /pbc McCallum L. Care of peripheral venous cannula sites. Nursing Times 2012; 108:12-15 Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J of Vas Sur. 2008;48: 55-80

11 Factors that determine type of VAD

12 Vascular Access Experience from 3 different centres

13 VADs for RBC exchange at Imperial College (Paediatric patients) Ong, M. Using peripheral venous access for automated exchange using Spectra Optia is safe and feasible for sickle cell disease in the paediatric population. Bone Marrow Transplant. 2013; 48:489

14 USG-PIVA at St. Georges

15 VADs used at UCLH ( ) 15

16 USG-PIVA at UCLH Upper arm ACF Lower Arm Basilic Brachial Ceph Ceph Brachial MedCubital Ceph Radial Basilic Cannulation episodes 109x 122x 8x 7x 41x 11x 7x 6x 9x Cannula Size 18g 18g 18g 18g/20g 18g/20g 18g/20g 20g 20g 20g/22g Inlet flow 45ml/min (30-68ml) 45ml/min (42-57ml)=18g 37ml/min (25 42ml)=20g 40ml/min (30-50ml) = 20g 30 ml = 22g Vein depth 5mm (2mm-12mm) 4mm (2mm-7mm) 4mm (2mm-8mm)

17 USG-PIVA literature overview Author (Year) Study type Apheresis procedure Notes Keyes (1999) Prospective study n/a A&E setting (101 pts; 91% success rate) Hanafusa (2015) Putensen et al. (2015) Salazar et al (2016) Mayhew and Stylianou (2017) Gopalasingam et al (2017) Report GMA 4 pts with poor venous access; total of 33 procedures successfully performed Prospective study RBC exchange 38 pt s; total of 84 procedures of which 85% (71 US cannulations) were successful, 49 CVC avoided Prospective study Retrospective study Prospective, descriptive study TPE, RBC exchange, CC CC TPE, ECP, CC 186 pt s; total of 831 procedures 20% decrease of pt s needing CVC 203 pt s; total of 383 procedures. Decreases CVC insertion from 33% to 7% over the study period Implementation of USG-PIVA in apheresis unit: decrease of CVC insertion from 45.8% (125 CVCs) to 13.2% (30 CVCs)

18 Access sites

19 19

20 Fistula Return line Access line 17 G Fistula needle

21

22

23 How to increase the number of peripherally placed cannulas? Elective Procedure? Make pre-procedure vein assessment mandatory Consider required Inlet Flow rates Cooperation (i.e., patient, parents, play specialist) Consider access sites beyond the ACF area Consider type of peripheral vascular access device Utilise vein-enhancing methods (e.g., warmth, hydration, etc.) Use technology (e.g., near infrared light or ultrasound devices) Etc.

24 ???

25 References for USG-PIVA Keyes et al. Utltrasound-Guided Brachial and Basilic Vein Cannulation in Emergency Department Patients With Difficult Intravenous Access. An Emerg Med. 1999; 34, Hanafusa N et al. Deep Vein Puncture Under Ultrasonographic Guidance An Alternative Approach for Vascular Access of Apheresis Theraphies. J Clin Apher [Internet] Available from: doi: /jca Putensen, D., Pilcher, L., Collier, D., McInerney, K. Ultrasound-guided peripheral deep vein cannulation to perform automated red cell exchange-a pilot study in a single centre. J Clin Apher. 2015; doi: /jca Mayhew M, Stylianou J. Ultrasound-guided peripheral vein cannulation reduces the need for central venous catheterization for peripheral blood stem cell harvest procedures. Poster presented at the 43 rd annual meeting of the European Society for Blood and Marrow Transplantation 2017, Marseille, France Salazar et al. Ultrasound-guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters. J Clin Apher [Internet] Available from: DOI /jca Gopalasingam et al. A successful model to learn and implement ultrasound-guided venous catheterization in apheresis. J Clin Apher [Internet] 2017.Available from: DOI: /jca.21533

Nursing Care of the Dialysis Patient. Adrian Hordon, MSN, RN

Nursing Care of the Dialysis Patient. Adrian Hordon, MSN, RN Nursing Care of the Dialysis Patient Adrian Hordon, MSN, RN Understand principles of hemodialysis Recognize different access ports Identify side effects and complications Discuss nursing care for pre and

More information

Percutaneous AV Fistula Creation. Ellipsys EndoAVF System

Percutaneous AV Fistula Creation. Ellipsys EndoAVF System Percutaneous AV Fistula Creation Ellipsys EndoAVF System Presented by Forest Rawls Jr CHT,CCHT-A,FNKF No Disclosures Various Access Types Some old Some new Scribner Shunt OUR OLD DEPENDABLE FRIEND

More information

Victoria Chapman BS, RN, HP (ASCP)

Victoria Chapman BS, RN, HP (ASCP) Victoria Chapman BS, RN, HP (ASCP) Considerations: Age Sex Body Composition Hydration Status Chemotherapy Use Access History Considerations: Immunosuppression Use Chemotherapy Frequency of plasma exchanges

More information

Sichol sooksee,rn. Hemodialysis Unit Rajavej Chiang Mai Hospital

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

More information

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 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

More information

Ultrasound for Vascular Access

Ultrasound for Vascular Access Ultrasound for Vascular Access Now pocket-sized, cordless, portable, and affordable. Introduction An estimated 300 million vascular catheters are placed every year in the United States making vascular

More information

Vascular Access Options for Apheresis Medicine

Vascular Access Options for Apheresis Medicine Vascular Access Options for Apheresis Medicine Josh King, MD Divisions of Nephrology and Medical Toxicology University of Virginia September 21, 2018 Disclosure I have no personal or professional financial

More information

A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports

A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports Disclosures A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports No conflicts of interest relevant to this presentation Jason W. Pinchot,

More information

Renal Physicians Association Kidney Quality Improvement Registry, Powered by Premier, Inc non-mips Measure Specifications

Renal Physicians Association Kidney Quality Improvement Registry, Powered by Premier, Inc non-mips Measure Specifications Renal Physicians Association Kidney Quality Improvement Registry, Powered by Premier, Inc. 2018 non-mips Measure Specifications Last updated January 2, 2018 RPAQIR1: Angiotensin Converting Enzyme (ACE)

More information

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 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

More information

IV therapy. By: Susan Mberenga, RN, MSN. Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

IV therapy. By: Susan Mberenga, RN, MSN. Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. IV therapy By: Susan Mberenga, RN, MSN 1 IV Therapy Types of solutions Isotonic Hypotonic Hypertonic Caution: Too rapid or excessive infusion of any IV fluid has the potential to cause serious problems

More information

What vascular access for which patient : obesity

What vascular access for which patient : obesity What vascular access for which patient : obesity C. Sessa, J. Coudurier A. De Lambert, C. Ducos, M. Guergour, O. Pichot Department of Vascular Surgery Grenoble France Controversies & Updates in Vascular

More information

NICE Guidance on Spectra Optia for automated red cell exchange in patients with Sickle Cell Disease

NICE Guidance on Spectra Optia for automated red cell exchange in patients with Sickle Cell Disease NICE Guidance on Spectra Optia for automated red cell exchange in patients with Sickle Cell Disease Dr Jo Howard Guy s and St Thomas NHS Foundation Trust Conflicts of interest Co-investigator/Key opinion

More information

Appendix E: Overview of Vascular

Appendix E: Overview of Vascular Appendix E: Overview of Vascular 56 Peripheral Short Catheter, less than 3 inches (7.5 cm) in length; over-the-needle catheter is most common. Inserted by percutaneous venipuncture, generally into a hand

More information

PARENTERAL NUTRITION: VASCUAR ACCESS DEVICE SELECTION

PARENTERAL NUTRITION: VASCUAR ACCESS DEVICE SELECTION PARENTERAL NUTRITION: VASCUAR ACCESS DEVICE SELECTION Winifred Magambo-Gasana Vascular Access Nurse Practitioner Oxford University Hospitals NHS Foundation Trust Aim An overview of the range of Vascular

More information

AV ACESS COMPLICATIONS. Ass. Prof. Dr. Habas

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

More information

Taking the Lead in Vascular Access Improving Patient Outcomes

Taking the Lead in Vascular Access Improving Patient Outcomes Taking the Lead in Vascular Access Improving Patient Outcomes Tricia Kleidon Nurse Practitioner Lady Cilento Children s Hospital Alliance for Vascular Access Teaching and Research (AVATAR) Menzies Health

More information

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 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

More information

Ultrasound Guided Vascular Access. 7/25/2016

Ultrasound Guided Vascular Access. 7/25/2016 Ultrasound Guided Vascular Access 7/25/2016 www.ezono.com 1 Objectives Indications for insertion of central and peripheral lines Complications associated with procedures Role of ultrasound in vascular

More information

TYPES AND USES OF VENOUS ACCESS DEVICES

TYPES AND USES OF VENOUS ACCESS DEVICES FOR HEALTHCARE PROVIDER USE ONLY. THIS INFORMATION IS FOR REFERENCE PURPOSES ONLY AND DOES NOT TYPES AND USES OF VENOUS ACCESS DEVICES PERIPHERAL DEVICES 1 Typically inserted in the hand, arm, or foot

More information

IN ARTERIOVENOUS FISTULA FAILURE

IN ARTERIOVENOUS FISTULA FAILURE DRUG ELUTING BALLOON ANGIOPLASTY IN ARTERIOVENOUS FISTULA FAILURE Nicola Troisi, MD GUIDELINES GUIDELINES VAS 2007 GUIDELINES VAS 2007 GUIDELINES VAS 2007 GUIDELINES VAS 2007 2007!!!!!!!!!! GUIDELINES

More information

Fistula/Graft Protection. Leslie Dork Renal Medicine Associates

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

More information

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 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,

More information

Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist Director, Blood Bank (DS & TS) / Stem Cell Cord Blood Bank Department of Pathology and

Hind Al Humaidan, MD, FRCPA Consultant Hematopathologist Director, Blood Bank (DS & TS) / Stem Cell Cord Blood Bank Department of Pathology and Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence Based Approach from the Writing Committee of the American Society for Apheresis: The 7th Special Issue Hind Al Humaidan, MD,

More information

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 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

More information

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation Vascular & Interventional Radiology Rotation 1 Core competency in vascular and interventional radiology during the first resident rotation consists of clinical objectives, technical objectives and image

More information

Apheresis Service Annual Haemoglobinopathy Course Sept, 2012

Apheresis Service Annual Haemoglobinopathy Course Sept, 2012 Apheresis Service Annual Haemoglobinopathy Course Sept, 2012 LUHANGA MUSUMADI Clinical Nurse Specialist Lead for Adolescent Transition Guy s & St Thomas NHS Foundation Trust Hospitals Luhanga.Musumadi@gstt.nhs.uk

More information

Selection of Permanent Hemodialysis Vascular Access

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

More information

Tasopoulou KM 1, Argyriou C 1, Mantatzis M 2, Kantartzi K 3, Passadakis P 3, Georgiadis GS 1

Tasopoulou KM 1, Argyriou C 1, Mantatzis M 2, Kantartzi K 3, Passadakis P 3, Georgiadis GS 1 Tasopoulou KM 1, Argyriou C 1, Mantatzis M 2, Kantartzi K 3, Passadakis P 3, Georgiadis GS 1 1 Department of Vascular Surgery, 2 Department of Radiology/Interventional Radiology Unit and 3 Department of

More information

WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? FISTULA/GRAFT

WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? FISTULA/GRAFT WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? FISTULA/GRAFT WHY DO I NEED VASCULAR ACCESS? For dialysis to work properly we need to create a way to take blood from your body, pass it through the dialyzer,

More information

Overview of CVADs. Type of device commonly used. Dwell time Flushing requirement Associated complications. lumens

Overview of CVADs. Type of device commonly used. Dwell time Flushing requirement Associated complications. lumens Source: Clinical Skills Management of Vascular Access Devices Pre-course handbook. Adapted with permission from NHS Lothian Employee and Education Development Team. Overview of CVADs Type of device Veins

More information

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? 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,

More information

MANITOBA RENAL PROGRAM

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

More information

MANITOBA RENAL PROGRAM

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

More information

Preservation of Veins and Timing for Vascular Access

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

More information

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 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

More information

Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)

Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure) Dialysis Vascular Access Coverage, Coding and Reimbursement Overview Hospital Outpatient 2019 Edition All Reimbursement Amounts are Listed at ational Unadjusted Medicare Rates and Do ot Include the 2%

More information

Case Study 1: Red Cell Exchange

Case Study 1: Red Cell Exchange Case Study 1: Red Cell Exchange Education Session VI: Pediatric Apheresis Leon Su, MD Section Chief, Transfusion Medicine and Apheresis None Disclosures 8 year old female SCD History of CVA in 2012 Hgb

More information

A New Technique to Superficialize Arteriovenous Fistulas Too Deep for Reliable Cannulation

A New Technique to Superficialize Arteriovenous Fistulas Too Deep for Reliable Cannulation A New Technique to Superficialize Arteriovenous Fistulas Too Deep for Reliable Cannulation Danielle Fontenot, MD, MS Adam Tanious, MD, MMSc, Yusuf Chauhan, BS Alicia Stafford, BS, Karl A. Illig, MD University

More information

HAEMODIALYSIS. Types of vascular access used for first haemodialysis 2012 to June 2016

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

More information

Research Article Comparison of Ultrasound Guided Radial Artery Cannulation with Conventional Palpation Technique

Research Article Comparison of Ultrasound Guided Radial Artery Cannulation with Conventional Palpation Technique Cronicon OPEN ACCESS ANAESTHESIA Research Article Comparison of Ultrasound Guided Radial Artery Cannulation with Conventional Palpation Technique Amna 1 *, Saira Mehboob 2, Waqas Alam 3, Amna Gulraze 4

More information

Physician Clinical Experiences with FIR Therapy in the UK and Taiwan

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).

More information

Dialysis Overview S J Fratesi MD FRCS

Dialysis Overview S J Fratesi MD FRCS Dialysis Overview 2005 S J Fratesi MD FRCS By the end of this session you should have an better understanding of : Ø Ø Ø Ø Ø Ø Ø Ø concept of dialysis alternative methods of dialysis indications for hemodialysis

More information

The following are the objectives to be successfully completed by the IR fellow at the completion of training.

The following are the objectives to be successfully completed by the IR fellow at the completion of training. GOALS and OBJECTIVES The following are the objectives to be successfully completed by the IR fellow at the completion of training. I. Patient Care Fellows must be able to provide patient care that is compassionate,

More information

Measure #330: Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days National Quality Strategy Domain: Patient Safety

Measure #330: Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days National Quality Strategy Domain: Patient Safety Measure #330: Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days National Quality Strategy Domain: Patient Safety 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES REGISTRY ONLY This is a

More information

HD Scanning: Velocities and Volume Flow

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

More information

Port Design. Page 1. Port Placement, Removal, and Management. Selecting a Vascular Access Device. Thomas M. Vesely, MD

Port Design. Page 1. Port Placement, Removal, and Management. Selecting a Vascular Access Device. Thomas M. Vesely, MD Non-Dialysis Procedures Port Placement, Removal, and Management Thomas M. Vesely, MD Saint Louis, Missouri Selecting a Vascular Access Device Duration of use Number of lumens Frequency used Blood flow

More information

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? 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

More information

PROVINCIAL STANDARDS & GUIDELINES

PROVINCIAL STANDARDS & GUIDELINES PROVINCIAL STANDARDS & GUIDELINES CARE OF NEEDLING SITES POST-HEMODIALYSIS FOR FISTULAS & GRAFTS (HEMOSTASIS) Updated July 2015 Approved by the BCPRA Hemodialysis Committee Table of Contents 1.0 Practice

More information

Safety of arteriovenous fistulae and grafts for continuous renal replacement therapy: The Michigan experience

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

More information

Technique of ultrasound guided peripheral venous access in the emergency room

Technique of ultrasound guided peripheral venous access in the emergency room Technique of ultrasound guided peripheral venous access in the emergency room Maria Giuseppina ANNETTA and Giancarlo SCOPPETTUOLO Catholic University, Rome, Italy Background Acutely ill pa?ents admiaed

More information

Children s Acute Transport Service

Children s Acute Transport Service Children s Acute Transport Service Vascular Access Document Control Information Author Ramnarayan Author Position Consultant, CATS Document Owner Polke Document Owner Position CATS Co-ordinator Document

More information

Case Endovascular management of non maturing dyalisis vascular access

Case Endovascular management of non maturing dyalisis vascular access Case 10238 Endovascular management of non maturing dyalisis vascular access Guedes Pinto 1, Erique; Madeira 2, Célia; Sousa 3, Marta; Penha 1, Diana; Rosa 1, Luís; Germano 1, Ana; Baptista 1, Manuela 1

More information

UC SF. End Stage Renal Disease. National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) BUT-- No Cephalic Vein What s Next

UC SF. End Stage Renal Disease. National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) BUT-- No Cephalic Vein What s Next No Cephalic Vein What s Next End Stage Renal Disease Charles Eichler MD Clinical Professor of Surgery Division of Vascular Surgery UCSF April 5, 2014 Population of patients with ESRD growing rapidly -

More information

BUTTONHOLE CANNULATION

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

More information

Renal Patient s Information Leaflet

Renal Patient s Information Leaflet Renal (Haemodialysis) Unit Patient Information Renal Patient s Information Leaflet Opening hours: If you need this information in large print, easy read, on audiotape or in another language please call

More information

NKF K/DOQI GUIDELINES

NKF K/DOQI GUIDELINES NKF K/DOQI GUIDELINES Executive Summaries Anemia Hemodialysis Peritoneal Dialysis Vascular Access Nutrition CKD 2002 Dyslipidemias Bone Metabolism Hypertension and Antihypertensive Agents Cardiovascular

More information

Sample page. POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.

Sample page. POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com. 2018 Complete Guide for Interventional Radiology An in-depth guide to interventional radiology coding, billing, and reimbursement for facilities and physicians POWER UP YOUR CODING with Optum360, your

More information

Arterial Puncture Wrist

Arterial Puncture Wrist Arterial Puncture Wrist Part No: KKM99 Radial artery puncture is a common approach for blood collection and artery catheterization, and this simulator provides realistic training in this skill. Palpation

More information

Arterial Puncture Wrist

Arterial Puncture Wrist U.S. Toll Free 866-GOLIMBS Venipuncture Arterial Puncture Wrist Part No: KKM99 Radial artery puncture is a common approach for blood collection and artery catheterization, and this simulator provides realistic

More information

Dialysis Event Protocol

Dialysis Event Protocol Dialysis Event Protocol Introduction In 2009, more than 370,000 patients were treated with maintenance hemodialysis in the United States. 1 Hemodialysis patients require a vascular access, which can be

More information

CATHETER REDUCTION. Angelo N. Makris, M.D. Medical Director Chicago Access Care

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

More information

National Institute for Health and Care Excellence Medical Technologies Evaluation Programme

National Institute for Health and Care Excellence Medical Technologies Evaluation Programme National Institute for Health and Care Excellence Medical Technologies Evaluation Programme MT271 Spectra Optia Apheresis System for automated red blood cell exchange in patients with sickle cell disease

More information

Central Venous Line Insertion

Central Venous Line Insertion Central Venous Line Insertion Understand the indications and risks of CVC insertion Understand and troubleshoot the seldinger technique Understand available sites and select the appropriate site for clinical

More information

No Place Like ehome. Anna Gozdzik. Contributors: Zita Abreu Jovina Bachynski Cyndi Bhola

No Place Like ehome. Anna Gozdzik. Contributors: Zita Abreu Jovina Bachynski Cyndi Bhola No Place Like ehome Anna Gozdzik Contributors: Zita Abreu Jovina Bachynski Cyndi Bhola ENABLE HOME OPTIMIZATION, MANAGEMENT AND EDUCATION Objectives Principle of shared decision-making Evolution of ehome

More information

Case #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty

Case #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty Unraveling the -59 modifier Principles of Interventional Coding Donald Schon, MD, FACP Debra Lawson, CPC, PCS Distinct or independent from other services performed on the same day Normally not reported

More information

Parenteral Nutrition in the Hospitalized Patient: which VAD, which policies? Rob Dawson DNP, MSA, APRN, ACNP-BC, VA-BC USA

Parenteral Nutrition in the Hospitalized Patient: which VAD, which policies? Rob Dawson DNP, MSA, APRN, ACNP-BC, VA-BC USA Parenteral Nutrition in the Hospitalized Patient: which VAD, which policies? Rob Dawson DNP, MSA, APRN, ACNP-BC, VA-BC USA Disclosure Consultant, Vascular Access Consultants LLC: Analogic, Inc / BK Ultrasound

More information

Chapter 2 Proximal Forearm Arteriovenous Fistula Creation

Chapter 2 Proximal Forearm Arteriovenous Fistula Creation Chapter 2 Proximal Forearm Arteriovenous Fistula Creation Venkat Kalapatapu and Andre Ramdon Introduction Worldwide greater than two million patients need renal replacement therapy. The aging population

More information

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 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

More information

Haemodialysis. Overview. Preparing for haemodialysis. Links to sections in topic Other topics available on website. Fistula

Haemodialysis. Overview. Preparing for haemodialysis. Links to sections in topic Other topics available on website. Fistula Haemodialysis This infokid topic is for parents and carers about children s kidney conditions. Visit www.infokid.org.uk to find more topics about conditions, tests & diagnosis, treatments and supporting

More information

Quality ID #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care

Quality ID #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care Quality ID #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:

More information

Dr. prakruthi Dept. of anaesthesiology, Rrmch, bangalore

Dr. prakruthi Dept. of anaesthesiology, Rrmch, bangalore CENTRAL VENOUS CATHETERIZATION Dr. prakruthi Dept. of anaesthesiology, Rrmch, bangalore OBJECTIVES Introduction Indications and Contraindications Complications Technique Basic principles Specifics by Site

More information

Vascular a ccess access for Dialysis a surgeon s perspecti e v. some observations

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

More information

Provider Type. Service Place

Provider Type. Service Place 34101 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION 01 00 10 2/1/1999 $118.00 34101 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT

More information

Venous Access and Ports. Helen Starosta

Venous Access and Ports. Helen Starosta Venous Access and Ports Helen Starosta Venous access and ports Peripheral IV access Arterio-Venous Fistula Central venous access Peripherally Inserted Central Catheter (PICC) Non Tunnelled Central Venous

More information

Unit 11. Objectives. Indications for IV Therapy. Intravenous Access Devices & Common IV Fluids. 3 categories. Maintenance Replacement Restoration

Unit 11. Objectives. Indications for IV Therapy. Intravenous Access Devices & Common IV Fluids. 3 categories. Maintenance Replacement Restoration Unit 11 Fluids, Electrolytes and Acid Base Imbalances Intravenous Access Devices & Common IV Fluids Objectives Review the purpose and types of intravenous (IV) therapy. Recall the nursing care related

More information

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 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

More information

Disclosure. Presented analysis part of larger study funded by Terumo BCT

Disclosure. Presented analysis part of larger study funded by Terumo BCT 1 Comparison of Transfusion Adverse Events in Children with Sickle Cell Disease (SCD) Receiving or Automated Red Blood Cell Exchange (arbx) Transfusions for Stroke Prevention Shannon Kelly, M.D. 2 Disclosure

More information

Cannulation Techniques Webinar

Cannulation Techniques Webinar Cannulation Techniques Webinar March 28, 2012 ESRD Network of Texas Lynda K. Ball, MSN, RN, CNN Objectives Discuss assessment skills inspection, palpation, and auscultation of an AV fistula to determine

More information

Veins that are firm to

Veins that are firm to Intravenous cannulation is a technique in which a cannula is placed inside a vein to provide venous access. Venous access allows sampling of blood as well as administration of fluids, medications, parenteral

More information

Int J Adv Med. For your questions please send message to

Int J Adv Med. For your questions please send message to Int J Adv Med SPECTRUM OF VASCULAR ABNORMALITIES IN COLOR DOPPLER EXAMINATION OF UPPER EXTREMITIES TESTED FOR SUITABLITY FOR AV FISTULA CREATION IN PATIENTS OF RENAL FAILURE. Journal Name : International

More information

2006 NKF-DOQI Guidelines Preferred Vascular Access Order 1. Radiocephalic (wrist) fistula 2. Brachiocephalic (elbow) fistula 3. Basilic vein transposi

2006 NKF-DOQI Guidelines Preferred Vascular Access Order 1. Radiocephalic (wrist) fistula 2. Brachiocephalic (elbow) fistula 3. Basilic vein transposi Stage 5 Chronic Kidney Disease Assessing the Results of AV Access: Realistic Outcomes in 2009 Sean P. Roddy, MD Albany, NY Defined as a GFR

More information

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 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

More information

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 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

More information

Catheter-directed Thrombolysis

Catheter-directed Thrombolysis Scan for mobile link. Catheter-directed Thrombolysis Catheter-directed thrombolysis treats vascular blockages and improves blood flow by dissolving abnormal blood clots. A blood clot, or thrombus, can

More information

Lutonix in AV fistula and Early look AV IDE trial data

Lutonix in AV fistula and Early look AV IDE trial data Lutonix in AV fistula and Early look AV IDE trial data Jackie P Ho Dept of Cardiac, Thoracic & Vascular Surgery National University of Singapore NUHS, Singapore Lutonix in AV fistula and final AV IDE trial

More information

WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? CATHETER

WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? CATHETER WHAT DO I NEED TO KNOW ABOUT MY VASCULAR ACCESS? CATHETER WHY DO I NEED VASCULAR ACCESS? For dialysis to work properly we need to create a way to take blood from your body, pass it through the dialyzer,

More information

PREVENTION AND TREATMENT OF ANEURYSMS OF AUTOGENOUS DIALYSIS ACCESSES STEPHEN L. HILL, M.D.,F.A.C.S

PREVENTION AND TREATMENT OF ANEURYSMS OF AUTOGENOUS DIALYSIS ACCESSES STEPHEN L. HILL, M.D.,F.A.C.S PREVENTION AND TREATMENT OF ANEURYSMS OF AUTOGENOUS DIALYSIS ACCESSES STEPHEN L. HILL, M.D.,F.A.C.S THE INCREASE IN THE CONSTRUCTION OF AUTOGENOUS FISTULAE OVER THE PAST TEN YEARS HAS BROUGHT WITH IT 1.

More information

Catheter Fracture of a Totally Implantable Venous Device Due to Pinch Off Syndrome in Breast Cancer: A Case Report

Catheter Fracture of a Totally Implantable Venous Device Due to Pinch Off Syndrome in Breast Cancer: A Case Report Kosin Medical Journal 2016;31:167-172. https://doi.org/10.7180/kmj.2016.31.2.167 KMJ Case Report Catheter Fracture of a Totally Implantable Venous Device Due to Pinch Off Syndrome in Breast Cancer: A Case

More information

2. Need for serial arterial blood gas determinations. 2. Anticipation of the initiation of thrombolytic therapy

2. Need for serial arterial blood gas determinations. 2. Anticipation of the initiation of thrombolytic therapy I. Subject: Arterial Cannulation II. Policy: Arterial cannulation will be performed upon a physician's order by Cardiopulmonary and Respiratory Therapy personnel certified in the arterial catheterization

More information

Erythrocytapheresis vs continuous Manual Exchange Transfusion to treat cerebral macrovasculopathy in children with sickle cell anemia

Erythrocytapheresis vs continuous Manual Exchange Transfusion to treat cerebral macrovasculopathy in children with sickle cell anemia Erythrocytapheresis vs continuous Manual Exchange Transfusion to treat cerebral macrovasculopathy in children with sickle cell anemia Bérengère KOEHL Malika BENKERROU WAA- 26/04/2016 Cerebral vasculopathy

More information

Portacath Insertion. Patient Information Leaflet

Portacath Insertion. Patient Information Leaflet Portacath Insertion Patient Information Leaflet What is a Portacath? A Portacath (also referred to as Port, Chemoport or Power Port) is an implanted central venous access device (CVAD) recommended for

More information

2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE

2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE 2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Central Venous Access s for Hemodialysis 2 Procedures Using Hemodialysis s 2 Physician Reimbursement for Hemodialysis s 3

More information

St George Hospital Renal Department Internal Policy

St George Hospital Renal Department Internal Policy COMPLICATIONS OF VASCULAR ACCESS FOR HAEMODIALYSIS. SUMMARY: Any type of complication for either a centrally placed venous catheter or arterio-venous fistula/graft can place the patient at risk of sub-optimal

More information

Central Line Care and Management

Central Line Care and Management Central Line Care and Management What is a Central Line/ CVAD? (central venous access device) A vascular infusion device that terminates at or close to the heart or in one of the great vessels (aorta,

More information

For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT

For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT - 8870390 METHOD/TECHNIQUE: The veins of the left upper extremity were studied at multiple For exam: VL DUPLEX EXTREMITY VEINS UNILAT RT - 8870400 METHOD/TECHNIQUE:

More information

National Surveillance System for Dialysis Centre and Dialysis Associated Diseases

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

More information

Measure #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care

Measure #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care Measure #329: Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES REGISTRY ONLY This is

More information

CENTRAL VASCULAR ACCESS DEVICE INSERTION AND THE RISK OF COAGULOPATHY

CENTRAL VASCULAR ACCESS DEVICE INSERTION AND THE RISK OF COAGULOPATHY CENTRAL VASCULAR ACCESS DEVICE INSERTION AND THE RISK OF COAGULOPATHY LYNN HADAWAY, M.ED., RN-BC, CRNI THE CLINICAL QUESTION What is the reported risk of bleeding during insertion of any type of central

More information