Invitation

Target Audience:

This workshop is designed for nephrology nurses novice in the management of vascular access for hemodialysis and in the use of bedside ultrasound for guided cannulation.

Program Objectives:

1. To facilitate the establishment of the hemodialysis vascular access by understanding the biological and biomechanical principles that affect fistula maturation

2. To facilitate the maintenance of the hemodialysis vascular access by understanding optimal cannulation techniques.

3. To understand the principles of bedside ultrasound to facilitate cannulation and evidence-based patient care

4. To review and evaluate the relevance of existing clinical practice guidelines for cannulation

5. To consider innovative research opportunities in vascular access cannulation.

Sandra Donnelly, MDCM, FRCPC, MSc

Chair, Access to Science in Hemodialysis

St. Michael’s Hospital Vascular Access Program

Access to Science in Hemodialysis: Principles of Vascular Remodeling

• To review the hemodynamic principles of vascular remodeling
• Defining “Good to Go” ….a paradigm shift
• To consider the hemodynamic implications of cannulation

What does make a difference in achieving the optimal vascular access:

Focus on the role of the nurse

• To identify the factors which influence patient decision making when deciding on choice of vascular access
• To identify the "best Practice" for nursing to support patient decision making

OBJECTIVES OF BPSO PROJECT

Accessing Expert Cannulators

• Developing the Resources and Staff to be Deemed Expert Cannulators in Hemodialysis
• Enhancing effective mentorship in the field
• Alignment of the Corporate Best Practice Guidelines – Professionalism in Nursing and Establishing Therapeutic Relationships.

OBJECTIVES OF WORKSHOPS

Workshop A: Imaging access for evaluation and cannulation site selection

• Principles of ultrasound use
• VA mapping (depth & length of cannulation segments, location of aneurysms, stenosis, calcification, collaterals, thrombus)
• Review images of ultrasound guided cannulation
• Buttonhole tunnel track location
• Hands on use of ultrasound for cannulation in phantoms

Workshop B: Cannulation techniques for graft and fistulae (hands on cannulation in artificial arms)

• Evaluation of access performance and selection of cannulation technique
• Selection of the needle/cannula (gauge, length), angle of cannulation
• Review of the different types of graft materials available
• Arm  positioning, use of tourniquet
• Cannulation differences between a fistula and a graft

Workshop C: Buttonhole Cannulation

• Inclusion/exclusion criteria for buttonhole creation
• Different methods of buttonhole creation
• Troubleshooting infiltration, inflammation, infection
• Location of the tunnel track with bedside ultrasound
• Pre needle insertion and post needle removal care

Workshop D:  Physiologic assessment of arteries

• To measure pulse wave velocity in brachial arteries
• To measure pulse wave form
• To understand the principles and practice of flow mediated dilatation