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Hemodialysis vascular access management in the Netherlands
Jan H M Tordoir1, Magda M van Loon, Margreet ter Meer
11 Department of Surgery, Maastricht University Medical Center, Maastricht - The Netherlands.
The Journal of Vascular Access
|March 10, 2015
Summary
Vascular access (VA) creation and maintenance are crucial for hemodialysis (HD) patients. Guideline implementation has improved preoperative assessment and postoperative surveillance, resulting in low VA thrombosis rates in the Netherlands.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access Management
Background:
- 86% of Dutch patients initiate renal replacement therapy with chronic intermittent hemodialysis (HD).
- Effective predialysis care and well-functioning vascular access (VA) are critical for managing renal failure.
- Timely referral and VA creation significantly impact VA type, success, and HD treatment outcomes.
Purpose of the Study:
- To assess the implementation of guidelines for vascular access (VA) creation and management in the Netherlands.
- To evaluate the timeliness of VA creation and the diagnostic and therapeutic methods employed.
- To determine the impact of guideline adherence on VA outcomes, particularly thrombosis rates.
Main Methods:
- A national questionnaire was distributed to dialysis centers to gather data on VA creation timelines, diagnostic methods, cannulation techniques, and thrombosis management.
- Data on the involvement of different medical specialists in central vein catheter insertion were also collected.
Main Results:
- VA creation occurred within 8 weeks in 73% of centers, with <4 weeks in 43%.
- Preoperative ultrasonography and postoperative flowmetry are widely used (98%). Rope-ladder cannulation is common (87%), with buttonhole technique used selectively.
- Endovascular intervention or surgery is employed for thrombosis in 66% of centers, with multidisciplinary meetings held in 57%.
Conclusions:
- Guideline implementation for VA creation and management has been successful in the Netherlands.
- Improved preoperative assessment and postoperative surveillance, including preemptive endovascular intervention, contribute to favorable VA thrombosis rates.
