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 treatment

Number of nurses and physicians in charge,

Descriptive paramters – per enrolled patient

Age & gender

Medical diagnoses, type of vascular access, including location

Status of AVF creation (primary, secondary, previous complications, etc.)

Medication

Dialysis prescription

Measured 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 Complications

Patency 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

Other

Swedwn

Latvia

Germany

Estonia

Poland

Portugal

Lithuania

Serbia

Greece

Spain

Romania

0 10 20 30 40 50 60

246666

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 !