Vascular Access Society Research Articles

Standardized Methodology for Duplex Ultrasound Examination of Arteriovenous Access for Hemodialysis: A Proposal of the French Society of Vascular Medicine and the French-Speaking Society of Vascular Access.

Duplex ultrasound (DUS) is an essential tool for characterizing and monitoring arteriovenous (AV) access for hemodialysis. The aim of the work described here, requested by the French Society of Vascular Medicine in collaboration with the French-Speaking Vascular Access Society, is to propose a standardized methodology for performing and documenting DUS, taking into account the variety of AV access techniques and the problems routinely encountered. A steering committee reviewed the literature and selected the relevant references. A draft was prepared, and all items with missing or conflicting data were submitted to a Delphi consensus. The final document was discussed and approved by all participants. The principles of DUS evaluation of AV access consist of examination of the afferent artery, the anastomosis and the entire venous drainage system. DUS uses B-mode ultrasound, color flow, pulsed wave and power Doppler analysis. DUS can be used in a variety of clinical situations, which can directly influence the methodology of the examination and the interpretation of the results. Blood flow should be assessed as it correlates with the risk of thrombosis. The measurement should be adapted to the different anatomical and hemodynamic conditions encountered. Characterization of stenosis should take into account the residual diameter of the drainage vein and its hemodynamic consequences. Other complications can be assessed with a standardized DUS examination. When performed according to a rigorous methodology, DUS of the AV access allows a comprehensive assessment of its functionality and eliminates the need for further invasive diagnostic procedures.

Abstracts to 13th Congress of the Vascular Access Society, 27th - 29th April 2023, Porto, Portugal

Restricted accessAbstractFirst published online June 15, 2023Abstracts to 13th Congress of the Vascular Access Society, 27th - 29th April 2023, Porto, PortugalOnlineFirsthttps://doi.org/10.1177/11297298231179064

UK Vessel Health and Preservation Framework 2020: a users’ survey

The review and update of the UK Vessel Health and Preservation Framework 2020 (VHP2020) was undertaken by a working group that included members of the Infection Prevention Society, the Royal College of Nursing, the National Infusion and Vascular Access Society and the Medusa Advisory Board and was launched in 2020. The VHP working group developed a survey to understand whether the VHP2020 had reached its intended audience, and what respondents thought were the benefits and drawbacks of its use in practice. Although the survey response was lower than expected, the responses received were largely positive and have provided feedback on how the VHP2020 is being used and some of the benefits. Most importantly, the survey has highlighted the need to communicate the benefits of the framework more effectively to reach a wider audience.

The case for implementing nurse-led vascular access service teams.

British Journal of NursingVol. 31, No. 19 CommentThe case for implementing nurse-led vascular access service teamsAndrew BartonAndrew Barton(E-mail Address: [email protected])Nurse Consultant IV Therapy and Vascular Access, Frimley Health NHS Foundation Trust, and Chair, NIVASSearch for more papers by this authorAndrew BartonPublished Online:28 Oct 2022https://doi.org/10.12968/bjon.2022.31.19.S6AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Barton A; for National Infusion and Vascular Access Society. The benefits of a nursing led vascular access service team: a white paper to outline a standardised structure and approach for the NHS to deliver vascular access services in every hospital, 2022. https://tinyurl.com/NIVAS-whitepaper-2022 (accessed 20 October 2022) Google ScholarCarr PJ, Moureau NL. Specialized vascular access teams. In: Moureau NL (ed). Vessel health and preservation: the right approach for vascular access. Cham, Switzerland: SpringerOpen; 2019 Crossref, Google ScholarGuerrero MA. National evaluation of safety peripheral intravenous catheters in a clinician-led project. Br J Nurs. 2019;28(2):S29-S32. https://doi.org/10.12968/bjon.2019.28.2.S29 Link, Google ScholarHamilton H, O'Byrne M, Nicholai L. Central lines inserted by clinical nurse specialists. Nurs Times. 1995;91(17):38–39 Medline, Google ScholarHarnage S. Seven years of zero central-line-associated bloodstream infections. Br J Nurs. 2012;21(21):S6-S12. https://doi.org/10.12968/bjon.2012.21.Sup21.S6 Link, Google ScholarHelm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203. https://doi.org/10.1097/NAN.0000000000000100 Crossref, Medline, Google ScholarJackson A, Coop S. Zero central-line infections in a 550-bedded district general hospital. Br J Nurs. 2012;21(14):S24, S26-S28. https://doi.org/10.12968/bjon.2012.21.Sup14.S24 Link, Google ScholarLoon FHJV, Puijn LAPM, Houterman S, Bouwman ARA. Development of the A-DIVA scale: a clinical predictive scale to identify difficult intravenous access in adult patients based on clinical observations. Medicine (Baltimore). 2016;95(16):e3428. https://doi.org/10.1097/MD.0000000000003428 Crossref, Medline, Google ScholarMoore A. Roundtable: ensuring safe vascular access. HSJ Guides. 2021. https://guides.hsj.co.uk/5921.guide (accessed 20 October 2022) Google Scholar FiguresReferencesRelatedDetails 27 October 2022Volume 31Issue 19ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 28 October 2022 Published in print 27 October 2022 Information© MA Healthcare LimitedPDF download

Global challenges with providing vascular access care during COVID era.

Background:The COVID-19 pandemic has adversely affected health care systems and dialysis access care in the US and across the globe. Beyond the initial challenges posed by the pandemic and despite the actions taken by health care leaders/organizations/professional societies such as the “Maintaining Lifelines for ESKD Patients” joint statement, there continues to be delays in providing timely care and performing elective and emergent dialysis access procedures worldwide. The aim of this study was to assess the global challenges associated with providing dialysis vascular access care across the international vascular access community during the pandemic.Methods:The American Society of Diagnostic and Interventional Nephrology (ASDIN) conducted an online survey in 2021, that was administered to an expert panel of dialysis vascular access specialists and global leaders spanning across the international community. The respondents who are members of ASDIN, Association of Vascular Access and InTerventionAl Renal physicians (AVATAR), Asia Pacific Society of Dialysis Access (APSDA), Peruvian Vascular Access Society (APDAV), and Australia/New Zealand Society of Interventional Nephrology (ANZSIN) reported their experiences in the care of dialysis vascular access, practice patterns, and challenges faced during the COVID pandemic.Results:Of the 53 individual surveys sent, 16 were opened and 11 (69%) responses were received from across the world and from different practice settings. The survey revealed the continued challenges facing the international community, the stark disparities in care delivery, supply chain disruption and logistical, regulatory, and financial issues that the global community continues to face in the ongoing pandemic.Conclusions:The COVID19 pandemic is far from over, and the challenges and barriers to providing dialysis access care seen on the initial ASDIN survey in the US seem to extend across the globe. We describe those results and discuss options, opportunities, and innovative tools to provide dialysis and access care during these trying times.

Lessons learnt and future directions in managing dialysis access during the COVID 19 pandemic: Patient and provider experience in the United States.

The COVID 19 pandemic adversely impacted delivery of preventive, routine, urgent, and essential care worldwide. Dialysis access care was particularly affected due to the lack of specific guidelines regarding procedures for its creation and maintenance. Early guidance by Centers for Medicare and Medicaid was inadvertently interpreted as guidance to stop dialysis access procedures. Prompt action by professional societies was needed to furnish detailed guidance to establish essential nature of these procedures. The American Society of Diagnostic and Interventional Nephrology (ASDIN) issued a joint statement with Vascular Access Society of the Americas (VASA) - "Maintaining Lifelines for ESKD Patients" to clearly establish the role of vascular access as a lifeline for ESKD (End Stage Kidney Disease) patients and the importance and urgency of its timely management. ASDIN also conducted a survey in mid-2020, that was administered to the ASDIN database as well as shared with the general public via the organization's social media platforms. The respondents reported their experiences in the care of dialysis access, practice patterns and the utility of the ASDIN-VASA statement during the COVID 19 pandemic. Of the 2030 individual surveys sent, 581 were opened and 53 (9.1%) responses were received from different parts of the country and from different practice settings. ASDIN COVID 19 triage document was frequently utilized and 83% of respondents found the document valuable. The survey also revealed multiple obstacles, including logistical and financial issues that led to significant disruption of services. The care of dialysis access was significantly affected in the United States during the COVID 19 pandemic due to multiple reasons. ASDIN actions provided valuable specific guidance regarding and explored barriers to dialysis access care. We describe those results and discuss strategies to prevent COVID 19 transmission with innovative strategies of providing access care. Individualized decision making is of essence when considering dialysis access procedures.

Managing Access by Generating Improvements in Cannulation: A national quality improvement project.

Cannulation is essential for haemodialysis with arteriovenous access, but also damages the arteriovenous access making it prone to failure, is associated with complications and affects patients' experiences of haemodialysis. Managing Access by Generating Improvements in Cannulation is a national UK quality improvement project, designed to improve cannulation practice in the United Kingdom, ensuring it reflects current needling recommendations. It uses a simple quality improvement method, the Model for Improvement, to structure improvement to cannulation practice. It assists units in the practical implementation of the British Renal Society and Vascular Access Society of Britain and Ireland needling recommendations, ensuring actual cannulation practice reflects what is defined as best practice in cannulation. An eLearning package and awareness materials have been developed, to assist units in changing their cannulation practice. The Kidney Quality Improvement Partnership provides a structure for Managing Access by Generating Improvements in Cannulation that promotes development and dissemination. It is hoped that Managing Access by Generating Improvements in Cannulation will raise an understanding about the cannulation of arteriovenous access and change behaviours and beliefs around correct cannulation practice, to ensure longevity of this lifeline.

COVID-19 and Renal Failure: Challenges in the Delivery of Renal Replacement Therapy.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first officially reported in December 2019 in Wuhan City, Hubei province, China, and has since lead to a pandemic. Most cases result in minor symptoms such as cough, fever, sore throat, myalgia, fatigue, nausea, diarrhea, loss of smell, and abdominal pain. As of April 8, 2020, more than 1,485,000 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in over 90,000 deaths. Outcomes are worse in elderly patients, particularly males, and those with comorbidities, but can affect any age group. The incidence of acute kidney injury in patients with COVID-19 infection is about 3-15%; and in patients with severe infection requiring care in the intensive care unit, the rates of acute kidney injury increased significantly from 15% to 50%. Acute kidney injury is an independent risk factor for mortality in COVID-19 patients. The nephrologists, as well as intensivists, are facing immense daily challenges while providing care for these patients in the inpatient setting as well as end-stage renal disease patients on chronic dialysis in both inpatient and outpatient settings. In the current review article, we discussed the epidemiology and etiology of acute kidney injury, management of acute kidney injury including renal replacement therapy options (both hemodialysis and peritoneal dialysis) for inpatient floor, as well as intensive care unit settings. We also discussed the challenges faced by the outpatient dialysis units with COVID-19 infection. We discussed measures required to limit the spread of infection, as well as summarized the guidance as per the Centers for Disease Control and Prevention (CDC), American Society of Nephrology (ASN), American Society of Diagnostic and Interventional Nephrology (ASDIN) and the Vascular Access Society of the Americas (VASA).

NIVAS 2019: facing the future in vascular access and infusion therapy.

The 7th National Infusion and Vascular Access Society (NIVAS) conference was held in Manchester, 12-13 June 2019.

Quality assessment of vascular access procedures for hemodialysis: A position paper of the Vascular Access Society based on the analysis of existing guidelines.

Quality assessment in vascular access procedures for hemodialysis is not clearly defined. The aim of this article is to compare various guidelines regarding recommendation on quality control in angioaccess surgery. The overall population of end-stage renal disease patients and patients in need for hemodialysis treatment is growing every year. Chronic intermittent hemodialysis is still the main therapy. The formation of a functional angioaccess is the cornerstone in the management of those patients. Native (autologous) arteriovenous fistula is the best vascular access available. A relatively high percentage of primary failure and fistula abandonment increases the need for quality control in this field of surgery. There are very few recommendations of quality assessment on creation of a vascular access for hemodialysis in the searched guidelines. Some guidelines recommend the proportion of native arteriovenous fistula in incident and prevalent patients as well as the maximum tolerable percentage of central venous catheters and complications. According to some guidelines, surgeon's experience and expertise have a considerable influence on outcomes. There are no specific recommendations regarding surgeon's specialty, grade, level of skills, and experience. In conclusion, there is a weak recommendation in the guidelines on quality control in vascular access surgery. Quality assessment criteria should be defined in this field of surgery. According to these criteria, patients and nephrologists could choose the best vascular access center or surgeon. Centers with best results should be referral centers, and centers with poorer results should implement quality improvement programs.

Needling recommendations for arteriovenous fistulae and grafts

The British Renal Society Vascular Access Special Interest Group and Vascular Access Society of Britain and Ireland recently launched their Needling Recommendations for Arteriovenous Fistulae and Grafts. Here, Fielding and colleagues describe the journey undertaken in developing these recommendations

Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction: Endorsed by the American Society of Diagnostic and Interventional Nephrology (ASDIN), British Society of Interventional Radiology (BSIR), Canadian Interventional Radiology Association (CIRA), Heart Rhythm Society (HRS), Indian Society of Vascular and Interventional Radiology (ISVIR), Vascular Access Society of the Americas (VASA), and Vascular Access Society of Britain and Ireland

Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction: Endorsed by the American Society of Diagnostic and Interventional Nephrology (ASDIN), British Society of Interventional Radiology (BSIR), Canadian Interventional Radiology Association (CIRA), Heart Rhythm Society (HRS), Indian Society of Vascular and Interventional Radiology (ISVIR), Vascular Access Society of the Americas (VASA), and Vascular Access Society of Britain and Ireland

Abstracts from the 10th Congress of the Vascular Access Society - Posters.

Abstracts from the 10th Congress of the Vascular Access Society, 5-8 April 2017, Ljubljana, Slovenia - Posters.

Abstracts from the 10th Congress of the Vascular Access Society - Oral presentations.

Abstracts from the 10th Congress of the Vascular Access Society, 5-8 April 2017, Ljubljana, Slovenia - Oral presentations.

Abstracts from VASBI Annual Meeting, 24-25 September 2015, Manchester - UK.

Abstracts from the Annual Meeting of the Vascular Access Society of Britain and Ireland, 24-25 September 2015, Manchester - UK.

Abstracts from the Inaugural Meeting of the Vascular Access Society of Britain and Ireland 2010, Manchester, UK, September 9-10, 2010

Abstracts from the Inaugural Meeting of the Vascular Access Society of Britain and Ireland 2010, Manchester, UK, September 9-10, 2010

Abstracts from the Inaugural Meeting of the Vascular Access Society of Britain and Ireland 2010, Manchester, UK, September 9-10, 2010

Restricted accessAbstractFirst published online January 18, 2018Abstracts from the Inaugural Meeting of the Vascular Access Society of Britain and Ireland 2010, Manchester, UK, September 9-10, 2010Volume 12, Issue 1https://doi.org/10.5301/112972981101200103

Abstracts from the Annual Meeting of the Vascular Access Society of Britain and Ireland

Restricted accessAbstractFirst published online October-December 2011Abstracts from the Annual Meeting of the Vascular Access Society of Britain and IrelandVolume 12, Issue 4https://doi.org/10.5301/JVA.2011.8828

The inaugural NIVAS conference

The inaugural conference of the National Infusion and Vascular Access Society (NIVAS) 'Infusing excellence and expertise' was held on 12th and 13th May 2010 at the Hotel Russell, London. It was attended by over 70 delegates and supported by 16 companies. The first day of the programme focused on reducing risk.

Approach for guideline development

The first wave of European Best Practice Guidelines (EBPG) in haemodialysis was completed in spring 2002 and was published in November 2002 in Supplement 7 of Volume 17 of Nephrology, Dialysis and Transplantation [1]. This issue contained the guidelines on: (i) measurement of renal function, when to refer and when to start dialysis; (ii) haemodialysis adequacy; (iii) biocompatibility; (iv) dialysis fluid purity; (v) chronic intermittent haemodialysis and prevention of clotting in the extracorporeal system; (vi) haemodialysis-associated infection and (vii) vascular disease and risk factors. From the start of the development procedure of the first wave, it had been decided that a second wave would follow, dealing with a remaining number of topics of interest. The first meeting of the work group responsible for the writing process was held on 8 April 2003. The following topics were to be dealt with: (i) intradialytic haemodynamic instability; (ii) vascular access; (iii) malnutrition and acidosis and (iv) dialysis strategies. Two other topics had originally been planned as well, but were abandoned at this early stage: (i) interdialytic hypertension, because it appeared that the Kidney Diseases Outcomes Quality Initiatives (K/DOQI), the body responsible for the generation of nephrological guidelines for the National Kidney Foundation (NKF) in the United States, was planning at that moment to produce extensive guidelines on this topic, as a section of the ‘Clinical practice guidelines for cardiovascular disease in dialysis patients’; in spring 2003 the K/DOQI were already far advanced in the preparation of these guidelines which were due for the beginning of 2005; (ii) Bone disease and mineral metabolism, because K/DOQI was on the verge of finalizing guidelines on this topic, whereas also the Kidney Disease: Improving Global Outcomes (KDIGO) initiative, a new emerging organization aiming at harmonization of guidelines worldwide and at producing new global guidelines, was preparing a consensus on the topic as well [2]. In June 2003, during the World Congress of Nephrology (WCN) in Berlin, representatives of the K/DOQI, KDIGO and EBPG met to discuss these issues. It was decided to offer the EBPG work group ample opportunity to have an input on the sections on interdialytic hypertension in the upcoming clinical practice guidelines for cardiovascular disease in dialysis patients of K/DOQI. As the latter were planned to contain recommendations on intradialytic haemodynamic instability as well, it was likewise decided that the EBPG work group would have an input in the generation of these recommendations as well. Since EBPG was planning specific and extended guidelines on this topic, however, rather than recommendations, and had the intension to cover a broader spectrum of questions based on a more extended literature review, it was decided to continue the foreseen development of guidelines on intradialytic haemodynamic instability by the EBPG. While starting the guideline development, it was decided to abandon the concept followed during the previous wave, where each topic was covered by one work group member, under peer review by the entire work group. For the upcoming wave, it was decided to compose subgroups with 3 to 4 experts, each with a chairman, having a coordinating role. The concept of peer review by the entire work group during the whole development process was, however, maintained. It was also decided that the work group on malnutrition would contain a dietician, and that the subgroup on vascular access would contain a vascular surgeon and an interventional radiologist. Furthermore, it was taken into account that the Vascular Access Society had published recommendations on vascular access, and care was taken to include members in the subgroup on vascular access, who had taken part in the development of these recommendations as well. The work group was composed after approval of its members by the European Renal Association – European Dialysis and Transplantation Association (ERA–EDTA) (Table 1). Each guideline was divided into a number of major subheadings (Table 2). Correspondence and offprint requests to: Raymond Vanholder, Department of Internal Medicine, Nephrology Science, OK12, University Hospital, Ghent, Belgium. Email: raymond.vanholder@ugent.be Nephrol Dial Transplant (2007) 22 [Suppl 2]: ii1–ii4