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Vascular access surveillance : the role of the access nurse in the renal dialysis unit.

conference contribution
posted on 2007-01-01, 00:00 authored by Monica SchochMonica Schoch, David McclureDavid Mcclure
Introduction
In January 2006, the Renal Dialysis Unit at Geelong Hospital appointed a Vascular Access Nurse. A Transonic Flow Qc HDO2 Ultrasound Dilution Monitor was purchased to monitor access flow and recirculation in arteriovenous fistulae in an attempt to predict AVF stenoses requiring early surgical correction.

Methods
A bi-monthly monitoring program tested all facility-based patients. 82 patients were assessed for access flow and recirculation between February and December 2006.

Results
18 (22%) had poor AVF function; 13 with access flows <500ml/minute on initial testing and 5 with an access flow decreasing >25% over a four month period. Of the 18 patients shown to have poor access flow, 2 died within one month of measurement while 5 were too frail to attempt corrective surgery. The remaining 11 proceeded to ultrasound or fistulography. A >50% stenosis was detected in all 11 cases. Of these, 4 had successful vein patch surgery and one had PTFE grafting, each with marked improvement in access flow. One had failed vein patch surgery requiring creation of a femoral AVF, one patient required cvc insertion to await AVF creation, and one had failed stenting requiring a permanent cvc. 3 died before planned surgery.

Conclusion
5 of the 82 patients that had access flow assessment, and needed further evaluation, proceeded to successful pre-emptive surgical intervention. We believe the Transonic is a useful adjunct to routine clinical AVF surveillance, in providing early evidence of AVF failure that can be avoided by pre-emptive surgery.

History

Event

Vascular 2007 Meeting (2007 : Melbourne, Vic.)

Pagination

1 - 3

Publisher

[The Meeting]

Location

Melbourne, Vic

Place of publication

[Melbourne, Vic.]

Start date

2007-08-17

End date

2007-08-22

Language

eng

Notes

Winner of 'Best Presentation' Award (Nursing) The Vascular 2007 meeting, held at the Melbourne Exhibition & Convention Centre from the 17th to the 22nd of August 2007 is a combined meeting of: The Australian and New Zealand Society for Vascular Surgery; The ANZSVS Vascular Imaging Symposium; The Victorian Chapter of the Society for Vascular Nurses Seminar; and The ANZ Chapter of the International Union of Angiology.

Publication classification

E2.1 Full written paper - non-refereed / Abstract reviewed

Title of proceedings

Vascular 2007 : Proceedings

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