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To Maximize the Creation of A.V. Fistulas: The Kaiser Way
Author(s) -
Cairoli Oscar
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.00012_1.x
Subject(s) - medicine , hemodialysis , nephrology , referral , dialysis , vascular access , fistula , arteriovenous fistula , surgery , peritoneal dialysis , hemodialysis access , kidney disease , general surgery , intensive care medicine , family medicine
First described by Brescia and Cimino in 1961 the A.V. fistula remains the best form of permanent vascular access. 24 to 27% of A.V fistulas thrombose within the first few postoperative weeks or fail to achieve sufficient caliber to permit cannulation. Most mature between two to six months. Once mature native fistulas have excellent long‐term patency rates and rarely become infected. A.V. fistulas can provide adequate vascular access for over 20 years. The importance of careful preparation for A.V. fistula placement months before the need for hemodialysis cannot be overemphasized. Planning the Kaiser way : Planning starts with the primary physician, screening the patients at risk: over 60 years old, diabetes mellitus, hypertension. The primary physician refers the patient to the nephrologist and renal team if the Cr. is 1.5 or higher for a female or 2.0 or higher for a male. During the early stages of the kidney disease, pre‐ESRD, the patient will be referred to the Choices Class to learn the different modalities (hemodialysis, peritoneal dialysis, and transplant issues). Once the nephrologist makes the decision that the patient will be on hemodialysis in the future, the patient is referred to the Renal Case Manager (RCM); he/she will initiate a referral to vascular surgery for evaluation of access placement. The RCM explains to the patient about the first surgical visit with the vascular surgeon, follows with surgery to be sure the appointment is made. When the access is placed, the RCM will do post surgical teaching on how to care for the new fistula. The patient will be followed, including the A.V. fistula, until the patient needs dialysis. If the fistula is not developing well, the RCM will notify the vascular surgeon for evaluation. Once the patient is ready for dialysis the patient is referred to the dialysis center. The RCM will follow up with the dialysis center and see how the access is working. If the fistula is questionable to use, the patient is first dialyzed as in‐patient to evaluate the access.