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S 27 Parallel Session

S 27 Vascular access
Saal 1, 28th September 2015, 16:00 – 17:30

Programme of the Session:

GS: Franzisca Frizen (Germany)
Best options for the creation of AV FISTULA/GRAFTs in diabetics

O 80
Tattoo of vascular cannulation site as a self-cannulation aid

Regin Lagaac (UK)

O 81
The importance of nurses´ role in the prevention of arteriovenous fistula complications

Elisabeta Rady (Romania)

O 82
Clinical practice guideline to assist healthcare professionals and patient decisions on needling technique

Ruth Dalton (Denmark)

O 83
Ultrasound mapping of new arteriovenous fistulae before the first cannulation - a case report

Lambros Theodosopoulos (Greece)


Best options for the creation of AV FISTULA/ GRAFTs in diabetics

F. Frizen

Abstract is not available.


O 80
Tattoo of vascular cannulation site as a self-cannulation aid

R. Lagaac1, A. Goh2, N. Pritchard1, R. Meruz1, N. Quian1
1Renal Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; 2Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

Background: Patients receiving home haemodialysis report a better quality of life over hospital dialysis. The home setting presents a challenge, as patients or their carers must be able to cannulate their fistula reliably and confidently.
Objectives: A patient, with Body Mass Index (BMI) of 36, had a left radiocephalic AVF formed. Home haemodialysis was initiated. Due to the difficulty in palpating the fistula, the patient would occasionally deviate from the prescribed direction of cannulation. This meant that the needle did not lie within the fistula and there was no flashback of blood or that the needle transected the fistula, resulting in infiltration. This happened on multiple occasions. Despite this, he was still keen to continue home dialysis.
Methods: It was proposed to mark the fistula margins with tattoo ink to help guide him with cannulation. Tattoo was placed in the radiology department.
Results: The tattoo served as a guide to the direction of cannulation. Following this simple procedure, he managed to self-cannulate over the past 5 months without any complications and there were no further referrals to the home therapies unit. Following this success, a further patient has received a similar tattoo to aid with cannulation.
Conclusion/Application to practice:This simple solution has enabled our patient to cannulate his fistula with confidence. This discreet solution could potentially be used when a fistula is difficult to palpate and the patient does not want a further superficialisation procedure. A tattoo could also be used in rural or satellite dialysis units where ultrasound is not readily available.

Disclosure: No conflict of interest declared

O 81
The importance of nurses´ role in the prevention of arteriovenous fistula complications
E. Rady1
1Dialysis, Fresenius Nephrocare Romania, Bucuresti, Romania

Background: Native vascular access is of great importance, as it is the optimal type of access for renal replacement therapies. Therefore, it is important to prevent complications that might compromise the arteriovenous fistula (AVF).
Objectives: To identify AVF complications at an early stage (by nurses) in order to facilitate the timely recovery of the AVF and preserve its long-term functional status.
Methods: During the study period in 2014, 257 AVFs were monitored. Clinical examination was performed by the nurse before, during, and after a haemodialysis session. A visual and tactile assessment was performed for skin changes - bruises, thinning, redness, pain, swelling, secretions, other inflammatory signs, difficult puncturing, hardening of tissue, prolonged post dialysis haemostasis time. In addition, assessment of AVF recirculation, patient complaints, specific parameters of a proper intradialysis flow of AVF, periodic serology results, and AVF echography were documented.
Results: In total, complications were reported in 36% of all evaluated AVFs. Complications included aneurysm (53%), vascular thrombosis (18.5%), venous stenosis (10.9%), inflammatory access or infection episodes (8.7%), prolonged haemostasis (5.4%), and other neuro-vascular problems (3.6%).
Conclusion/Application to practice: Due to nurses’ vigilance and the monitoring programme, AVF complications could be identified. We assume that a good collaboration between the dialysis nurse and the patient and the entire medical team can clearly increase the AVF lifetime by means of preventing specific complications thus increasing the quality of the entire treatment performance.

Disclosure: No conflict of interest declared

O 82
Clinical practice guideline to assist healthcare professionals and patient decisions on needling technique
R. Dalton1, A.H. Mortensen1, K. Henriksen1, J. Finderup1
1The Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark

Background: Patients with chronic renal failure undergoing haemodialyssis treatment are having needles inserted in their arteriovenous fistula (AVF) at least three times a week. This exposes patients to discomfort and anxiety related to needling more than three hundred times a year. There are two needling techniques that are recomended; rope-ladder technique using sharp needles and buttonhole technique using blunt needles. But there are no evidence-based clinical guidelines for healthcare professionals and patients, when they have to make a shared decision on needling technique.
Objectives: To assist healthcare professionals and patients in shared decision making on needling technicque.
Methods: Teh PICO method was used to describe the four elements of the clinical question, which acts as a framework throughout the development of the clinical guideline. A team consisting of a nurse with master qualification, a vascular access coordinator, a registered nurse with years of experiences in haemodialysis and the unit's research nurse reviewed relevant studies identified by a systematic search of the literature on studies comparing complications due to rope-ladder- and buttonholde technique.
Results: Six studies were included for at systematic review using the AGREE instrument to assess the methodological quality and the reliability and validty of the studies. Clinical practice gudielines have been systematically developed comparing the rate of formation of haematoma, aneurisms, haemostasis, bad needle sticks, AVF-survival, AVF-related infections and patient-reported pain.
Conclusion/Application to practice: Clinical practice guidelines assist healthcare professionals and patients in making decisions about appropriate needling technique.

Disclosure: No conflict of interest declared

O 83
Ultrasound mapping of new arteriovenous fistulae before the first cannulation- a case report

L. Theodosopoulos1, D. Topka2, A. Mpokari1, E. Sarris1
1Hemodialysis unit, West Attica General Hospital, Agia Varvara, Greece; 2Internal medicine, Faculty of nursing-university of Athens, Athens, Greece

Background: It is important that the first cannulation attempts to a new arteriovenous fistulae (AVF) are successful and without any complications. This is why many haemodialysis units have protocols that first cannulations are carried out by experienced nurses. Ultrasound mapping of the new AVF is performed in our dialysis unit by a nurse prior to the first cannulation attempts. This protocol has very positive outcomes and it is reported for the first time nationwide.
Methods: Case report: We present the case of A.M., a 60 year old patient in our unit undergoing a three times a week schedule of haemodialysis since March 2009. The patient’s first vascular access was a temporary central venous catheter, followed by two unsuccessful PTFE grafts. The new radiocephalic AVF that was created in September 2013 was neither visible nor palpable even by experienced nurses four months later. This was because the patient was overweight and the vein was too deep. Using ultrasound imaging we mapped the anastomosis and the useable course and length of the developed veins. A drawing with permanent marker on the patient's skin was used to show the actual course of the veins and data such as depth, diameter, angulations, stenosis, thickness of wall and other anatomical details were recorded. This information contributed to minimal complications during the first cannulations. The patient is at present being cannulated by all the nurses in our unit and complications are rare.

Disclosure: No conflict of interest declared