Guidelines on Vascular Access Cannulation and Care

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. 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 Project Objectives:

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. 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. 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 • Patencyimpairment, indicated by • QBdrop* <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. Vascular Access Project Status Development of Guideline: • Project Team Members kick-off meeting: • 18.19 of April 2013 Picture * attributable to AVF (complication)

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

10. 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 44different 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. 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 2012 - 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 !