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S 15 Parallel Session
Programme of the Session
Title: Safe vascular access
GS: Jose Ibeas (Spain)
Doppler Ultrasound for arteriovenous fistula: A third generation method for first approach
O 24
Metal versus plastic cannula use for haemodialysis, an open label trial
Kay McLaughlin (New Zealand)
O 25
Identifying barriers to implementing rope ladder cannulation
Dexie Marquez (United Arab Emirates)
O 26
Does vascular access management improve outcomes? Portuguese experience
Telmo Carvalho (Portugal)
O 27
Improving vascular access cannulation technique: the power of education
Maria Teresa Parisotto (Germany)
Abstracts
GUEST SPEAKER
Doppler Ultrasound for arteriovenous fistula: A third generation method for first approach
Jose Ibeas1
1Nephrology Department, Parc Tauli Sabadell, University Hospital Barcelona, Spain
Vascular Access (VA) complications produce high morbi-mortality, worsened quality of life, hospitalizations and costs. Screening of pathology with the first generation methods is very specific but no sensitive. That it means that in this way pathology is usually late diagnosed and VA can be loosed. Second generation methods are based in flow determination. The techniques used are based or in dilution methods or in Doppler ultrasound (DU). DU it was usually reserved for selected patients by its dependence of other departments.
DU has the advantage of flow measurement and image study in the same examination. Latest Spanish 2016-Guidelines advise for surveillance with flow measurement and use of US in the diagnosis of pathology, with angiography only for selected cases.
The possibility of incorporate the US in the Hemodialysis Unit has made possible the pathology screening and its precise diagnosis in the same act, giving the opportunity not only to do flow screening but the image control of stenosis, masses and collections or the determination of confusing or alternative collaterals. Allows treatment prioritization depending on the flow rate or dangerous findings like pseudoaneurysms, can permit treatment orientation to surgical, interventional or even conservative approach and even the mapping looking for new VA placement. Finally, is a fundamental tool with the possibility of the US guided puncture, mainly in the deep vessels or in pathological VA waiting for treatment. All this create a new concept in nephrology, the US as a third generation method that can be used in the first approach.
BIOGRAPHY OF THE GUEST SPEAKER
O 24
Metal versus plastic cannula use for haemodialysis, an open label trial
K. McLaughlin1
1Renal Service, Capital and Coast District Health Board, Wellington, New Zealand
Objectives
To compare complication rates between plastic and metal cannulae when accessing new arteriovenous fistula for haemodialysis.
Methods
An open label trial was conducted involving 3 groups of 10 patients, all with arteriovenous fistula that had never been cannulated before. The first 6 cannulation sessions were included for each patient to enable any complications to b recorded and compared between the patient groups. Group 1 included random cannulators using standard metal dialysis cannulae; group 2 used expert cannulators and plastic cannulae and group 3 combined expert cannulators with metal cannulae in an attempt to reduce bias.
Results
There were a total of 180 cannulation sessions recorded. Patients who had a random cannulator using metal cannulae (Group 1) were more likely to have complications compared to the expert cannulators using the same metal cannulae (Group 3), (odds ratio, 2.8; 95% CI, 1.28 - 6; p=0.010). Patients who had the same group of expert cannulators using plastic cannulae (Group 2) were less likely to have complications compared to when they used metal cannulae (Group 3), (odds ratio, 0.34: 95% CI, 0.13 - 0.89:p= 0.028).
Conclusion/Application to practice
Plastic dialysis cannulae are a safe and effective alternative to metal cannulae for accessing arteriovenous fistula and appear to reduce the occurrence of complications during the initial cannulation period. The expertise of the cannulator plays a key role in successful cannulation and when combined with using plastic cannula, resulted in better outcomes.
O 25
Identifying barriers to implementing rope ladder cannulation
D. Marquez1, N. Alqaissi2, D. Dowsett3, C. Greenway3, P. Byers3, A. Cullimore1, N. Richards1, M. Richards1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates; 2Nursing, Fatima College of Health Science, Abu Dhabi, United Arab Emirates; 3Faculty of Health, De Montfort University, Leicester, United Kingdom
Background
Dialysis prevalence in Abu Dhabi is about 1000 per head of the population with 95% receiving haemodialysis of which 70% have either an AV fistula or AV graft. Because of the high volume of needle insertions, the site selection for each cannulation is paramount in the preservation of the vascular access. There are three different needling techniques of which rope ladder is most commonly recommended and is policy in our units
Objectives
To undestand the barriers to adherence to the rope ladder cannulation policy.
Methods
A survey was developed using a Likert scale which collected nursing demographics and looked at three domains, nursing knowledge, nursing skills and experience and patient factors.
Results
10 responses were obtained, 60% female, 80% with more than 3 years of dialysis experience. The awareness of the benefits of rope ladder cannualtion and of the local policy were very high but respondents appeard to lack training in its introduction. Nurses lacked confidence in the use of the technique particularly when under time pressure. They felt that there was a lack of monitoring of adherence to the policy. There is a perception that patients do not like rope ladder due to anxiety over the use of a new site, increased pain and increased liklihood of infiltation.
Conclusion/Application to practice
Whilst there is an understanding that rope ladder cannualtion is the preferred method to successfully impement such a policy, a nurse and patient education programme is required to provide support for the nurses and a clear understanding to the patients of the benefits of the procedure.
O 26
Does vascular access management improve outcomes? The Portuguese experience
T. Carvalho1, J. Fazendeiro Matos2, M.T. Parisotto3
1Centro de Acessos Vasculares NephroCare Lisboa, Fresenius Medical Care, Lisboa, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3Care Value Management EMEA, Fresenius Medical Care, Bad Homburg, Germany
Background
The conversion to a capitation system for dialysis payment, which includes the Vascular Access responsibility, required the definition and implementation of a dedicated program to meet these new challenges.
Reimbursement for chronic dialysis represents a substantial portion of healthcare costs for a relatively small part of the total population. Dialysis reimbursement costs are generally between €20,000-€80,000 annually per individual, depending on the country and the strategy. Since April 2008, Portuguese health authorities convened with dialysis providers a capitation package, and in 2011, the vascular access (VA) management was included in the capitation budget.
Objectives
To determine the health quality improvements related to VA management by the dialysis providers.
Methods
A retrospective analysis of VA characteristics and hospitalizations related to vascular access between 2011 and 2014.
Results
In 2010 the number of hospitalizations caused by vascular access complications were 651, resulting in a total of 3029 hospitalization days and representing 18.31% of all hospitalizations.
Between 2011 and 2014 there was a relevant decrease in the number of hospitalizations due the vascular access complications compared to 2010 (-43.8%) and hospitalizations days (-49.8%), representing savings of €1,500,000/year for the National Health Service. During this period in a populations of around 4500 patients there was an improvement in AVF of 70.1% (+4.2%), reducing the AVG to 15.8% (-2.1%) and catheter to 14.8% (-2.1%).
Conclusion/Application to practice
VA management with Vascular Access Centres reduces VA related hospitalizations decreasing morbidity and mortality, improving patient clinical outcomes and economical and organizational outcomes for the National Health Service.
O 27
Improving vascular access cannulation technique: the power of education
M.T. Parisotto1, F. Pelliccia1, C. Miriunis1, I. Morris1
1Fresenius Medical Care, Nursing Coordination, Bad Homburg, Germany
Background
Haemodialysis nurses have predominately on-the-job training. We would observe whilst our preceptor would cannulate patients who had arteriovenous fistula (AVF), and then we would be given the needles and expected to perform a cannulation. Haemodialysis nurses knowledgeable and skilful in vascular access are crucial to ensure the correct cannulation technique is performed and they must maintain knowledge of current developments.
Objectives
To provide training in a well prepared, well-structured and appropriate manner, enabling haemodialysis nurses to choose the most appropriate cannulation technique.
Methods
Creation of a vascular access learning tool to ensure staff have the knowledge to enable them to perform the best type of cannulation technique.
Results
All nurses in the network undertook the VA e-learning course with an average score of 82points out of 100. To evaluate the training’s learning effectiveness in daily practice, data was extracted for patients having an AVF from 2009 (N=10,807) and 2015 (N=18,164) for cannulation technique, direction of arterial needle, bevel position and needle rotation. Comparing results of 2009 vs 2015, cannulation technique distribution was as follows: rope-ladder 31.0% vs 56.2%, area 61.0% vs 29.2% and buttonhole 6.1% vs 14.6% of patients. Arterial needle direction antegrade 67.0% vs 75.1%; bevel position upwards 73.3% vs 34.7 %; needle rotation yes 56.4% vs 12.4% of patients.
Conclusion/Application to practice
The creation of a vascular access learning tool is essential for teaching the basics of needle cannulation in an appropriate, well prepared and well-structured manner, working towards having all dialysis staff members understand and master the basics of vascular access cannulation.
BIOGRAPHY OF THE SPEAKER