1. Guidelines on Vascular Access Cannulation and Care
Joint project of EDTNA/ERCA and Fresenius Medical Care to achieve enhanced multidisciplinary renal team practice in dialysis and establish VA guidelines

2. Project Coordinators:
Maria Teresa Parisotto - General and Scientific Coordinator on behalf of Fresenius Medical Care
Jitka Pancirova - General Coordinator on behalf of EDTNA/ERCA
Jean Pierre Van Waeleghem - Scientific Coordinator on behalf of EDTNA/ERCA

3. Project Objectives:
Raise awareness for the importance of vascular access management as the “patient’s lifeline”
Define vascular access cannulation practices based on clinical evidence (six months observational study) to minimize complications
Develop guidelines for vascular access cannulation and care

4. √ √ − Vascular Access Project Status Project Framework Definition
Preparation of Observational Study Protocol (VASACC)
Selection of Participating Countries and Centres
Data Collection (Jan - Jul 2013) √
Data Analysis (Aug - Dec 2013)
Development of Vascular Access Guidelines (Jan - Jun 2014)
Launch of Vascular Access Guidelines - EDTNA/ERCA 2014 −

5. Data Collection study beginning:
Vascular Access
Project Status
Data Collection study beginning:
Descriptive parameters – per centre
Number of patients on chronic HD treatment
Number of nurses and physicians in charge,
Descriptive paramters – per enrolled patient
Age & gender
Medical diagnoses, type of vascular access, including location
Status of AVF creation (primary, secondary, previous complications, etc.)
Medication
Dialysis prescription
Measured dialysis dose Kt/V

6. Data Collection per patient per treatment:
Vascular Access
Project Status
Data Collection per patient per treatment:
VA - General setting
AVF localisation (forearm, elbow, upper arm, other)
Needle characteristics (size, back-eye (y/n), sharp vs. blunt)
Medication with impact on coagulation
VA - Cannulation technique
Rope ladder vs. area vs. button hole
Antegrade vs. retrograde puncture
Distance between needle puncture sites (<3, 3-6, >6 cm)
Primary bevel-up vs. bevel-down
Needle rotation after insertion (y/n)

7. Vascular Access Project Status Outcome parameters: VA Complications
Patency impairment, indicated by
QB drop* <50% of prescribed value
Signs and symptoms of fistula thrombosis or manifest occlusion
AVF infection (necessary: evident local signs)
Haematoma with swelling and/or induration
Numbers of punctures >=4 / session
Hospitalisation*
Death*
* attributable to AVF (complication)

8. Development of Guideline:
Vascular Access
Project Status
Development of Guideline:
Project Team Members kick-off meeting:
18.19 of April 2013
Picture
* attributable to AVF (complication)

9. Project Team Memebers:
Vascular Access
Project Status
Project Team Memebers:
Team Members (EDTNA/ERCA and FME):
Iris Romach, Theodora Kafkia, Raffaella Beltrandi, Joao Fazendeiro, Ricardo Peralta, Mihai Preda, Alberto Iglesias, Nicola Ward, Iain Morris, Francesco Pelliccia, Cristina Miriunis, Jean Pierre van Waeleghem.
Picture
* attributable to AVF (complication)

10. Definition of Guideline Outline:
Vascular Access
Project Status
Definition of Guideline Outline:
Workshop
Home work
Pictures
* attributable to AVF (complication)

11. Vascular Access Project Status Next Steps: Literature research
Development of Guideline full content
Revision of the content
Endorsement of VAS
Final revision
Printing
Distribution at the next EDTNA/ERCA conference
* attributable to AVF (complication)

12. Results from the VA Survey 2012
For the third consecutive year a questionnaire about vascular access assessment was distributed at the Strasbourg Conference 2012 in seven languages.
A total of 9xxx participants from more than 44 different countries participated in the survey.

13. Which Country are you from?
% of Completed Questionnaires per European Country
N. of Country 44

14. How many Years have you been Working in Dialysis?

15. In which setting are you working?

16. Which needle do you remove first?

17. How do you perform haemostasis after removing the needle?

18. Are you in favour of asking for patient’s help, by applying pressure during haemostasis?

19. Depending on the characteristics of the patient, on average how long does the haemostasis of a puncture site take?
Multiple answers were possible

20. In your opinion, should vascular access care be included in a patients training and education programme?

21. Is there currently a vascular access training programme
for patients in your centre?

22. In your opinion is the current patient’s training and education
programme for vascular access sufficient?

23. In your opinion who should be responsible for organising a
training and education programme?

24. (1 for most important, 6 for the least important)
Please rank the following topics on a scale of 1 to 6 according to importance when teaching a patient about vascular access.
(1 for most important, 6 for the least important)

25. On a regular basis, do you currently use a vascular access
monitoring tool in your clinic?

26. Who is the professional in charge of organising the vascular access monitoring programme on regular basis?

27. VA Survey Conclusion
43.7% of participants work in public hospitals
The first needle removed is the arterial one (82%)
77.5% of the respondents consider the current patient’s training and education programme for vascular access sufficient
For 75.6% of the respondents, the professional in charge of organising the vascular access monitoring is the nurse, followed by the nephrologist with 18.5% and vascular access surgeon with 5.8% .

28. Thank you ! Vielen Dank ! Merci beaucoup ! ¡Muchas gracias !
Obrigado !
Grazie Mille !
Mulţumesc !
Děkujeme !
Dziekuje !
Teşekkür Ederim !
Sagolun !
Hvala !
Köszönöm !