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Vascular Access — Is Your Patient Running Out of Options?

Vascular Access — Is Your Patient Running Out of Options?

If you work as a dialysis provider long enough, you’re guaranteed to have some difficult conversations. Some of these conversations will be with family. Some of them will be with patients. Some of them will be with other care providers. No doubt the hardest conversations to have are the ones where you have to talk about running out of options.

Don’t get me wrong. There are lots of options when it comes to dialysis. For example, most patients can choose what method of dialysis they want to do and where to do it. There are treatment options that can be done in the comfort of your own home and there are treatment options that are offered in medical care settings. No matter what setting you choose there are still options.

Being a dialysis patient isn’t unlike any other chronic illnesses in that the longer you live with the condition the fewer the options there often are. Being a dialysis patient also isn’t unlike other chronic illnesses in that there will be complications. But what if some of the complications along the way were preventable? And what if some of those preventable complications reduce your options for continued treatment?

One of the hardest conversations I’ve had as a dialysis nurse was with a patient who was out of options for access placement if the one she was currently using failed. Unfortunately, she also wasn’t ready for the end of life. Let’s not forget dialysis is a life sustaining treatment and without it the patient will die.

Access placement is a necessary part of receiving dialysis treatments no matter what method of treatment you choose and has often been referred to as the patient’s lifeline. For the purpose of this conversation, we are going to focus on AV accesses used for hemodialysis.

There are three main types of accesses a patient can use for hemodialysis: an arteriovenous (AV) fistula, an arteriovenous (AV) graft, or a central venous catheter. Each access has complications and risks associated with it, but the AV fistula has the least and is the preferred option when possible, followed by the AV graft.

Dialysis providers are responsible for monitoring the patient’s access for things such as signs of infection, indications of failure, or indications of a potential complication. For the AV fistula and graft, the most common complication is the development of stenosis which if not treated proactively can lead to thrombosis. Thrombosis is an AV access complication that is often considered preventable since there are typically clinical indicators and surveillance data that indicate a problem is developing.

This is where we, as dialysis providers, can help our patients maintain the health and patency of their current AV access so that they don’t run out of options. It is our responsibility to use the best tools available to recognize potential complications and take action when appropriate. In fact, the fundamentals of access care have long told us that monitoring for clinical symptoms and using surveillance data will help detect access dysfunction that when treated can lead to a reduction in thrombosis and improved quality of care for our patients.

Vasc-Alert surveillance reports have been highly recognized as efficient tools to identify patients whose accesses are at risk of complication allowing providers the ability to refer the patient for access evaluation and treatment before it’s lost to thrombosis. Vasc-Alert users have reported that they are often able to identify trends in the surveillance data that alerts them to a developing problem before some patients even begin to present clinical symptoms.

Vasc-Alert has two main prioritization reports: the number of alerts for each patient and the access risk score. Alerts are issued when a patient has consistently elevated intra-access pressure measurements. The access risk score is a triage approach and uses a 1 to 10 scale to identify the patients with the highest risk of complication based on multiple factors found in the treatment data such as intra-access pressures, achieved blood flow rates, and characteristics of the access. Below are some examples of each of these Vasc-Alert reports.

Venous Access Pressure Ratio Trend

Higher scores indicate higher risk of access complication.

Venous AccessPressure Ratio Trend

Triage List with Access Risk Score

Triage list with access risk score

The closing question you should ask yourself is are you using all the best tools available to ensure the best care for your patients?  Don’t let your dialysis patients run out of options.  Vasc-Alert can help you identify accesses at risk and reduce thrombosis events so that your patients’ fistulas and grafts can last longer and they can achieve quality dialysis treatments.