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Vascular Access Cannulation and Care Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula Editors Maria Teresa Parisotto Jitka Pancirova Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula This book is an initiative of Maria Teresa Parisotto (Director Nursing Care Management, NephroCare Coordination, Fresenius Medical Care Deutschland GmbH), Germany and Jitka Pancirova, (EDTNA/ERCA Executive Director), Czech Republic Authors of this best practice guide are: Alberto Garcia Iglesias RN, Spain Cristina Miriunis RN, B.Ec., Germany Dr. Francesco Pelliccia RN, MSc, Italy Iain Morris RN, United Kingdom Iris Romach RN, MA, Israel Joao Fazendeiro Matos RN, BSc, MBA (c), Portugal Mihai Preda RN, Dipl.-Ing., Romania Nicola Ward RN, United Kingdom Raffaella Beltrandi RN, Italy Ricardo Peralta RN, BSc, Portugal Theodora Kafkia RN, MSc, PhD (c), Clinical Lecturer, Greece Contributors to this best practice guide are: Jean Pierre Van Waeleghem RN, BSN, Belgium Victor Moscardó RN, Germany Dr. Frank Laukhuf MD, Nephrologist, Germany Volker Schoder M.Sc., Dipl. Statistician, Germany Prof. Dr. Daniele Marcelli MD, MBA, Nephrologist, Epidemiologist, Germany Dr. Adelheid Gauly PhD, MBA, Germany Dr. Stefano Stuard MD, PhD, Nephrologist, Germany Reviewers of this best practice guide are: Dr. Richard Fluck FRCP, MA (Cantab), MBBS, Nephrologist Immediate past President, British Renal Society, United Kingdom Dr. Maurizio Gallieni MD, FASN, Nephrologist, Researcher at University of Milan President, the Vascular Access Society, Italy Dr. Otto Arkossy MD, Nephrologist Board Member of the Hungarian Society of Nephrology, Hungary Emine Unal RN, Turkey Natalie Beddows RN, United Kingdom Marjelka Trkulja RN, EDTNA/ERCA Brand Ambassador, Croatia All rights are reserved by the author and publisher, including the rights of reprinting, reproduction in any form and translation. No part of this book may be reproduced, stored in a retrieval system or transmitted, in any form or by means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Illustrations included in this publication are property of Fresenius Medical Care Deutschland GmbH and cannot be used without prior permission of the owner. First edition: September 2014 European Dialysis and Transplant Nurses Association/ European Renal Care Association (EDTNA/ERCA) Pilatusstrasse 35, CH 6003 Lucerne, Switzerland www.edtnaerca.org ISBN: 978-84-617-0567-2 D.L.: M-17528-2014 Layout, Binding and Printing: Imprenta Tomás Hermanos Río Manzanares, 42-44 · E28970 Humanes de Madrid Madrid - Spain www.tomashermanos.com 7 Acknowledgements Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula 8 Acknowledgements This book is an initiative of Fresenius Medical Care and EDTNA/ERCA. We warmly thank the authors, the contributors and the reviewers for their collaboration and enthusiasm on this project. The content created is an excellent example of multidisciplinary, international teamwork, developing best practice guide for the most important aspect of the haemodialysis patient’s care. Editors Maria Teresa Parisotto, Director Nursing Care Management, NephroCare Coordination, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany Jitka Pancirova, EDTNA/ERCA Executive Director, Prague, Czech Republic Sponsor Fresenius Medical Care Deutschland GmbH has kindly supported the development of “Vascular Access Cannulation and Care. A Nursing Best Practice Guide for Arteriovenous Fistula”. This handbook is the result of the project. Acknowledgements 9 11 Table of Contents Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula 12 1. Preface .................................................................................. 17 2. Executive summary ............................................................... 23 3. Introduction ............................................................................ 27 3.1 Aims for the use of this best practice guide .................... 29 3.2 Groups likely to benefit from this best practice guide...... 29 3.3 Scope of this best practice guide..................................... 30 4. Background............................................................................. 33 5. Vascular Access for Haemodialysis........................................ 37 5.1 VA types........................................................................... 38 6. Arteriovenous Fistula.............................................................. 41 6.1 Timing for Arteriovenous Fistula creation......................... 42 6.2 Selection of vessels......................................................... 46 6.2.1 Artery...................................................................... 46 6.2.2 Vein........................................................................ 47 6.3 Location of Arteriovenous Fistula creation....................... 48 6.4 Surgical technique of anastomosis creation.................... 49 6.5 Maturation........................................................................ 51 6.5.1 Physiology of maturation........................................ 51 6.5.2 Timing of maturation............................................... 52 6.6 Failure of Arteriovenous Fistula maturation..................... 53 6.6.1 Instrumental monitoring of Arteriovenous Fistula maturation.............................................................. 54 Table of Contents 13 7. Hygiene and infection control ................................................ 57 7.1 Hand hygiene .................................................................. 58 7.2 Personal Protective Equipment (PPE) and work uniform .. 60 7.2.1 Gloving .................................................................. 60 7.2.2 Face protection ..................................................... 61 7.2.3 Aprons and gowns ................................................ 61 7.2.4 Uniforms ................................................................ 61 8. Arteriovenous Fistula cannulation .......................................... 63 8.1 Competencies and responsibilities ................................. 64 8.2 Preparation and assessment .......................................... 65 8.2.1 Preparation ............................................................ 65 8.2.2 Assessment ........................................................... 68 8.2.3 Arteriovenous Fistula preparation ......................... 69 8.3 First cannulation .............................................................. 70 8.3.1 Procedure .............................................................. 70 8.4 Cannulation techniques .................................................. 75 8.4.1 Rope ladder ........................................................... 76 8.4.2 The buttonhole technique ...................................... 79 8.4.3 Area technique ...................................................... 83 8.4.4 Trypanophobia (fear of needles) ........................... 86 8.5 Needle removal and Haemostasis .................................. 86 8.6 Complications related to Arteriovenous Fistula Cannulation .90 8.6.1 Haematoma/infiltration .......................................... 90 8.6.2 Pseudo-Aneurysm ................................................. 91 8.6.3 Infections ............................................................... 93 Vascular Access Cannulation and Care A Nursing Best Practice Guide for Arteriovenous Fistula 14 9. Complications of Arteriovenous Fistula (related to the fistula) .. 97 9.1 Stenosis .......................................................................... 98 9.2 Thrombosis ................................................................... 101 9.3 Aneurysms .................................................................... 103 9.4 Complications caused by the Arteriovenous Fistula .... 105 9.4.1 Cardiac Complications ....................................... 105 9.4.2 Steal syndrome .................................................. 106 10. Arteriovenous Fistula monitoring and evaluation .................. 111 10.1 Arteriovenous Fistula monitoring ................................ 112 10.1.1 Dynamic venous and arterial pressures evaluation ............................................112 10.1.2 Measurements of blood recirculation ............... 113 10.1.3 Dialysis efficiency ............................................. 114 10.1.4 Arteriovenous Fistula instrumental evaluation . 113 11. Reporting of Arteriovenous Fistula incidents ....................... 117 11.1 What, When and Why to report .................................. 118 11.2 Reporting tools ............................................................ 126 11.2.1 Paper charts ...................................................... 126 11.2.2 E-charts ............................................................. 127 11.3 Corrective actions........................................................ 128 11.4 Follow-up of corrective actions .................................... 129 Table of Contents 15 12. Patient education for the care of Arteriovenous Fistula ....... 131 12.1 Preservation of vessels prior to Arteriovenous Fistula creation ........................................................... 133 12.2 Arteriovenous Fistula care .......................................... 134 12.2.1 Creation ............................................................. 134 12.2.2 Arteriovenous fistula maturation
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