RESUMEN
Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.
Asunto(s)
Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Cateterismo Venoso Central , Catéteres Venosos Centrales , Humanos , Diálisis Renal/métodos , Cateterismo Venoso Central/métodosRESUMEN
The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.
Asunto(s)
Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Humanos , Antebrazo/irrigación sanguínea , Antebrazo/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Grado de Desobstrucción Vascular , Diálisis Renal , Venas/diagnóstico por imagen , Venas/cirugía , Drenaje , Resultado del TratamientoRESUMEN
The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.