1. Managing VA in haemodialized patients – the patient and clinicians view point S. Matthew & S Bell

2. Pre-dialysis- patient pathway
Patient education (preparation for dialysis)
Duplex
Assessment for vascular access
Review by surgeon
Surgery
Surveillance
Post fistula creation care
Cannulation

3. Vascular Access Clinician What is vascular access?
Why does a patients need vascular access for dialysis?
Types of Vascular Access.
Order of site choice (Radiocephalic vs Brachiocephalic)
Patient education

4. Vascular Access Formation – a patient’s perspective
patients’ perception of fistulas
- Risk of failure depending on site
- Risk of requiring further surgery/ intervention
- Appearance (aneurysmal)
- Infection risk 4

5. Assessment for Vascular Access Creation
Clinician
Timing of creation: Too early? Too Late?
Can we determine which vessels will fail?
Can imaging assist planning?
- Options for imaging- pros/cons
- Duplex: relies on operator skills?
- CT: risks of contrast nephropathy/ radiation exposure/ cost
- Venography- invasive, associated risk
- MRI- Nephrogenic Systemic Fibrosis with gadolinium
- Newer, safer agents ? Cost ? Accessibility

6. Vascular Access Creation
Fistula
Intervention
Successful
Failure
How can we reduce failure & fistula complication?

7. Fistula Cannulation Patient
Self-cannulation versus multi-user or single nurse cannulation
Cannulation technique: Button hole vs rope ladder?
Infection control
Clinician
Infection & complication rates
Difference in surveillance between centres?
Risks and limitations?

8. Cannulation Techniques
1. Rope-ladder puncture
2. Area puncture
3. Buttonhole puncture

9. Dundee Surveillance
Duplex 6 weeks, 12 weeks and 6 monthly post fistula creation
Transonic 3 monthly unless problem identified
Intervention- immediate duplex, 6 weeks, 12 weeks and 6 monthly
Intervention- monthly transonics for 3 months then 3 monthly
Monthly MDT to discuss problems- interventional radiologist, vascular access specialist nurse, vascular surgeons, vascular laboratory, nephrologist