Vascular Access Medical Team: Organic Models

Abstract

At present day, nephrologists have to face all clinical aspects linked to chronic kidney disease, especially those related to hemodialysis therapy. Nephrologists themselves have to provide vascular access from arrangement to surveillance and upkeep to provide patients less discomfort as possible in starting hemodialytic treatment. Despite other European and extra – European countries, vascular access policy it's not standardized in Italy; every Dialysis Unit provides itself confident with own nephrologists skill and experience without any team work, but only founded on individual availability. Taking a look on Italian vascular access historical background, we have selected three managements approaches linked both to historical background and, on the other hand, to development of new medical devices and specialized know – how. First approach to vascular access policy has to be identified with nephrologist who prepare and completely manage vascular access for hemodialysis treatment; second approach detect nephrologist as physician who delegates vascular access packaging to vascular surgeon or other surgeons losing data on patient's vascular outcome. Ideal picture should be so called “integrated structural model” in which vascular surgeon and operative radiologist interact with nephrologist who manage all vascular access packaging process. This approach should include professional responsibilities among various physicians sharing vascular access packaging together with refunds from local governments. D.R.G. based refund can affect treatment's policy of chronic kidney disease patients and our health departments do not pay enough attention to vascular access management. We have to plan all strategies to better identify and minimize every kind of clinical risk trying to reward the teamwork efforts. It's time to understand that vascular access policy has to take part of hemodialysis therapy quality standard; we have also to underline that the “integrated structural model” actually represent our best solution at disposal.