15_4_2
Volume 15, Number 4, pages 30 - 33
Revisiting Quality Standards in Hemodialysis Vascular Access: Where is the Bar?
By Alison Thomas
Abstract
Vascular access performance is closely linked to adequacy of hemodialysis. Clinical practice guidelines are available to assist practitioners in determining best practice in the area of hemodialysis vascular access. For various reasons, in Canada, there is a lower than recommended rate of arterio-venous (AV) fistula use and an increasing trend toward use of central venous catheters (CVC) for hemodialysis access. The result is an environment wherein hemodialysis nursing staff has an important role to play in addressing barriers to fistula prevalence and maximizing opportunities for fistula creation. Moreover, meeting standards for blood flow with all vascular accesses including CVCs in day-to-day practice is paramount to hemodialysis adequacy and positive outcomes. Through a case study approach, this manuscript revisits the existing standards for vascular access including CVC function, discusses the importance of meeting those standards to achieving hemodialysis adequacy, and discusses the use of thrombolytic therapy as a potential strategy for the management of catheter malfunction.
Learning Objectives
After reading the article, the reader will be able to:- Recognize the important relationship between vascular access performance and hemodialysis adequacy
- Discuss the role of the nephrology nurse in achieving vascular access standards as outlined by KDOQI and the Canadian Society of Nephrology
- Describe the problem of hemodialysis central venous catheter (CVC) malfunction and the role of thrombolysis in restoration of function
- Understand the barriers to arterio-venous (AV) fistula creation and identify some strategies to overcome those barriers.
Author Affiliation(s): Alison Thomas, RN, BScN, CNeph(C), is CNS/NP, Hemodialysis, St. Michael's Hospital, Toronto, Ontario.