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![Page 1: Guidelines on Vascular Access Cannulation and Care Joint project of EDTNA/ERCA and Fresenius Medical Care to achieve enhanced multidisciplinary renal team.](https://reader030.fdocuments.in/reader030/viewer/2022033104/56649d0a5503460f949dd49e/html5/thumbnails/1.jpg)
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
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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
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• 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:
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√ 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−
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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
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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)
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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)
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Vascular Access Project Status
Development of Guideline:
* attributable to AVF (complication)
Project Team Members kick-off meeting:
18.19 of April 2013
Picture
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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
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Vascular Access Project Status
Definition of Guideline Outline:
* attributable to AVF (complication)
Workshop
Home work
Pictures
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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
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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.
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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
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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%
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In which setting are you working?
43.7%
56.3%
Public hospital Private centre
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Which needle do you remove first?
82.0%
18.0%
Arterial needle Venous needle
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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%
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Are you in favour of asking for patient’s help, by applying
pressure during haemostasis?
87.5%
12.5%
Yes No
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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%
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In your opinion, should vascular access care be included in a patients training and education programme?
Yes No
87.0%
13.0%
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Is there currently a vascular access training programme for patients in your centre?
Yes No
69.6%
30.4%
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In your opinion is the current patient’s training and education programme for vascular access
sufficient?
Yes No
77.5%
22.5%
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In your opinion who should be responsible for organising a
training and education programme?
Nurses Nephrologists
66.3%
33.7%
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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%
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On a regular basis, do you currently use a vascular access monitoring tool in your clinic?
Yes No
50.8%
49.2%
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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%
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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% .
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Thank you !Vielen Dank !Merci beaucoup !¡Muchas gracias ! Obrigado !Grazie Mille !Mulţumesc !Děkujeme !Dziekuje !Teşekkür Ederim !Sagolun !Hvala !Köszönöm !