Vascular Access Practice Patterns in Canada: A National Survey.

Area of Science:

• Nephrology
• Vascular Surgery
• Healthcare Policy

Background:

• The Canadian Society of Nephrology's Vascular Access Working Group (CSN VAWG) aims to inform the nephrology community about current vascular access (VA) practices in Canada.
• A national survey was conducted to understand VA practice patterns across the country.

Purpose of the Study:

• To document VA practice patterns, including fistula creation and maintenance, in Canada.
• To assess clinician consensus on fistula creation suitability and identify barriers and facilitators.

Main Methods:

• A national survey was developed and administered to nephrologists, surgeons, and nurses involved in VA programs.
• The survey covered practice patterns in access creation and maintenance, indications/contraindications for arteriovenous (AV) access, and facilitators/barriers to fistula use.

Main Results:

• 82% of invited participants completed the survey, predominantly nurses, nephrologists, and surgeons.
• Significant practice variations were observed in preoperative assessment, fistula maturation interventions, and AV access salvage procedures.
• Limited consensus existed on AV access contraindications, except for limited life expectancy and poor preoperative vasculature.
• Primary fistula failure and long maturation times were common barriers; surgical wait times and multidisciplinary team access were also cited.

Conclusions:

• Substantial variation in VA practice and limited consensus on fistula contraindications exist among Canadian clinicians.
• Further high-quality research is recommended to guide clinical practice regarding appropriate fistula placement.