Vascular access management

Vascular access is frequently referred to as the ‘patient lifeline’. Given the vital importance of this topic NephroCare has developed numerous tools and services focusing on the management and care of vascular access. More than a decade of experience in our NephroCare clinics has given us a high level of renal care expertise which we constantly reinvest in the NephroCare network in the form of guidelines and best practice approaches enriched and guided by NephroCare Coordination services and tools.

The Arteriovenous Fistula (AVF)

The Arteriovenous Fistula (AVF) is well-recognised worldwide as the access of choice in haemodialysis patients.

Many programmes are mainly directed at improving fistula rates but the experience of the surgeon and the quality of dialysis patient care staff may impact the success of the AVF.

For the majority of patients, before starting haemodialysis a plan for evaluation and placement of an AVF should be in place.

Patients who use an AVF report better overall general health, ability to engage in physical activity, energy, and emotional social well-being compared to patients using a Central Venous Catheter (CVC).

Central Venous Catheter (CVC)

A Central Venous Catheter (CVC) is a foreign body that may incite chronic inflammation and thus lead to malnutrition, anaemia, and cardiovascular disease. It may deliver lower than expected blood flows and inefficient dialysis from access recirculation and thereby predispose to underdialysis.

Complications related to prolonged haemodialysis catheter use include increased morbidity, mortality, and cost.

On average, patients with CVC are more likely to get a vascular access related infection, spend on average more days per year in hospital and have two times the risk of death compared to patients who use an AVF.

Responsibility for initiating the process lies with the nephrologists who also have the scientific know-how to better understand for which category of haemodialysis patients the CVC still remains an alternative.

Supporting Vascular Access Management at clinic level

The connection and disconnection procedures for arteriovenous fistula and grafts and for central venous catheters are described in detail in the NephroCare Standard Good Dialysis Care.

To support the easy connection and disconnection of patients in line with the NephroCare Standard Good Dialysis Care and NephroCare Guideline Hygiene and Infection Control requirements the proHD Set as well as the proHD CVC Set have been developed in our clinics. These sets are the result of investigating and understanding clinical needs followed by a technical market screening.

The publication of the “Vascular Access Cannulation and Care Guide - A Nursing Best Practice Guide for Arteriovenous Fistula” is the result of a joint project between Fresenius Medical Care and EDTNA/ ERCA.

The knowledge and research for the preparation of the Guide was supported by NephroCare clinic data collected through a dedicated vascular access module in EuCliD.

The Vascular Access Module, also called VASACC, was designed for use by the nurses to collect data from every treatment about

  • Cannulation technique
  • Bevel orientation during cannulation
  • Distance between arterial and venous needle
  • Arterial needle direction
  • Needle rotation (after needle insertion)
  • Number of repeated punctures in case of difficult cannulation
  • Vascular access assessment for signs and symptoms of infection and occlusion

This module was intended to monitor in depth the factors influencing vascular access survival and to improve the process of early recognition of vascular access failure risks.

To support on-site training in dialysis centres an extended e-Learning Course on Vascular Access has been created. The course is split into the three main modules: Arteriovenous Fistula, Arteriovenous Graft and Central Venous Catheter and covers the creation, maturation, care and management of all types of vascular accesses used for dialysis.

This dedicated expertise inside our NephroCare network contributes to further best practice knowledge in the vascular access field.

Endovascular Services and Vascular Access Surgeries

NephroCare dialysis centres provide high levels of expertise for the development and management of Vascular Access Centres (VAC) which perform endovascular services and vascular access surgery.

Monitoring Vascular Access Achievements

Vascular Access Management is an integral part of the NephroCare Excellence program and contributes to the optimisation of CKD therapies to improve patient outcomes. The NephroCare Excellence program is translated into operation through target agreements for dedicated Key Performance Indicators which are monitored through the Balanced ScoreCard.