Abstract
In 2010, the Canadian Society of Nephrology vascular access working group (CSN VAWG) was established, with its initial mandate to inform the Canadian renal community about our vascular access performance nationally, and to promote more functioning fistulas in incident and prevalent hemodialysis patients while reducing catheter use. The focus then transitioned to the development and provision of a vascular access curriculum that details the fundamentals of vascular access knowledge for nephrologists, nephrology trainees, and the dialysis community in support of their continued education. The intention of this vascular access education program is to provide the reader with a thorough understanding of the following: 1) the various vascular access types; 2) the detailed patient evaluation required to assist with decision making 3) the management and maintenance of a well- functioning vascular access 4) potential access-related complications and strategies for intervention.
This education program is created by a group of nephrologists, members of the Canadian Society of Nephrology (CSN) Vascular Access Work Group (VAWG), who are passionate about vascular access and actively engaged in vascular access practice improvement, education, and/or research in their own province. The authors consist of 2 teams: one tasked with the arteriovenous access (both fistula and graft) articles and the other with hemodialysis catheter articles. Each team included 4-6 people who performed an exhaustive literature review, consulted with local experts when required and drafted each article. Extensive consultation and feedback for each article was obtained from all members of both teams via meetings, teleconferences, and email throughout the writing process from June 2014 to December 2015. Each article went through multiple reviews and revisions followed by external review by a non VAWG member nephrologist with either medical education expertise or vascular access expertise. Subsequently, all articles were extensively expanded to include appropriate details that could fulfill the needs of our targeted readership. Final iterations of all articles were disseminated to all members of the CSN VAWG for external peer review, before manuscript submission to the Canadian Journal of Kidney Health and Disease.
The first 3 articles of the education program focus on the arteriovenous access, with article (Arteriovenous vascular access selection and evaluation) emphasizing considerations in the decisions around placement of the arteriovenous access, the role of the multidisciplinary team, arteriovenous access surgical creation, physiologic changes associated with fistula maturation, as well as principles of cannulation. Article (Arteriovenous access failure, stenosis and thrombosis) discusses primary failure, patency rates, and interventions for stenosis and thrombus of the arteriovenous access. Article (Arteriovenous access: infection, neuropathy and other complications) highlights other arteriovenous access complication such as steal syndrome, neurologic sequelae, and high output cardiac failure. Articles are concentrated on issues surrounding the central venous catheter, in which article (Practical aspects of nontunneled and tunneled hemodialysis catheters) presents a general overview of non-tunneled and tunneled catheters, including catheter selection, placement, and removal. Article (Hemodialysis tunneled catheter-related infections) discusses catheter-related infections, with comprehensive review of preventive measures and treatment options, including catheter care, antimicrobial locking solutions and systemic antibiotics. The final article (Hemodialysis tunneled non-infectious complications) addresses non–infection-related complications including catheter dysfunction, thrombus, and central vein stenosis.
This body of work is not intended to substitute for evidence based guidelines. Instead, we hope that it will serve as a valuable resource for educators, nephrologists and students of all disciplines (nursing, surgery, radiology, etc) seeking a comprehensive summary of vascular access topics. In conjunction with this publication in the Canadian Journal of Kidney health and Disease, we have created a complete PowerPoint slide set designed to simplify knowledge transfer. These materials will be available to anyone visiting the CSN website, and it is our hope that they will be incorporated into individual education programs.