How data can help reduce vascular access events.

Thrombosis is the leading cause of access dysfunction and is expensive to treat. In 2011, only 10 AV access capable patients in our center were placed on a bridge catheter because of our ability to assess health and proactively use angioplasty to keep it open. Surveillance also helped us follow the progression of new fistula maturation and helped us decide on early intervention to prevent total, access failure. The Sparrow Center documented successful results with the selection of a new surveillance system that dramatically improved the quality of patient care and financial viability of the center. For dialysis center staffs looking for ways to operate more efficiently and at the same time reduce the incidence of vascular access complications caused by thrombosis, a data-driven surveillance device along with clinical monitoring protocols seems to provide a cost effective approach to addressing this critical area of patient care.

Improving arteriovenous fistula cannulation skills.

Cannulation of arteriovenous fistulae is technically more challenging than cannulation of arteriovenous grafts. With the advent of the National Vascular Improvement Initiative, Fistula First, the United States has seen an increase in the number of arteriovenous fistulae. The problem we now face is how to refocus and reeducate nurses to the intricacies of arteriovenous fistula cannulation. Through evidenced-based practice and current best-demonstrated practices, this article will provide the tools needed to improve arteriovenous fistulae cannulation skills.

Detecting hemodialysis vascular access stenosis: a tracking tool.

A tool for tracking indicators of hemodialysis vascular access stenosis is described to facilitate documentation of early signs of stenosis. Prompt notification of the nephrologist, and referral to an interventional radiologist for percutaneous transluminal angioplasty may prevent more costly interventions or hospitalizations, and even loss of the permanent access. Inadequate dialysis and its complications may be avoided by nursing observation and documentation of indicators known to be predisposing factors to hemodialysis vascular access stenosis.

Caring for patients undergoing treatment for vascular occlusion.

In the treatment of arterial and graft occlusion, St George's Hospital has moved the emphasis away from long infusions of streptokinase to short, high-dose, pulsed administration of recombinant human tissue-type plasminogen activator (rt-PA). This has led to a change in nursing management.