1 Escola Superior de Enfermagem do Porto, Porto, Potugal; 2 Escola Superior de Enfermagem de. Coimbra, Coimbra, Portugal

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1 6th Congress of Nephrology in Internet November 2011 CARE FOR THE PERSON WITH ARTERIOVENOUS FISTULA Model for Continuous Improvement Clemente Sousa 1 ; João Apóstolo 2 ; Maria Henriqueta Figueiredo 1 ; Manuela Martins 1 1 Escola Superior de Enfermagem do Porto, Porto, Potugal; 2 Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal

Apóstolo 2 ; Maria Henriqueta Figueiredo 1 ; Manuela Martins 1 1 Escola Superior de

2 The Person with Chronic Kidney Disease Evolves in a silent, progressive and irreversible; Repercussions individual/family and social; 19,2 million Americans, 11% of the adult population 1 ; people with Chronic Kideney Disease in Portugal 2 ; 8454 people in dialysis (389 in PD and 8065 in HD) 3 growing at 6% per year 2 ; Mobilizes ±2% of resources health 4 ; PUBLIC HEALTH PROBLEM 1 Schoolwerth, A., et al. (2006). Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis [serial online], pp Pereira, P. (2008). Em Portugal existem 14 mil pessoas em diálise ou transplante. Saúde Pública, Sociedade Portuguesa Nefrologia, S. (2005). Relatório Anual Lisboa. 4 Matesanz, R. (2006). El milagronde los trasplantes de la donación órganos a las células madre. Madrid: Esfera de los Libros.

Schoolwerth, A., et al. (2006). Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis [serial online], pp. 1-6. 2 Pereira, P. (2008).

3 Practice Care of People with End Stage Renal Disease (ESRD) Century XX Until the late and 60 After the 60 Relief of Symptoms Monitor Realization of the treatment of HD Biomedical Model The Practice of Nursing focus on the renal replacement treatment Sousa, C. N. (2009). Cuidar da Pessoa com Fístula Arteriovenosa: dos pressupostos teóricos aos contextos das práticas. Dissertação de Mestrado apresentada a Instituto Ciências Biomédicas Abel Salazar da Universidade do Porto.

replacement treatment Sousa, C. N. (2009).

4 State of the Art of Vascular Access It s essential to dialysis; Molilizes 17% of the resources available for HD, in USA 1 ; Interdisciplinary team to optimize the longevity of vascular access 2 ; Nurses has specific requirements on the team 2 ; Has the responsability to detect early vascular access dysfunction 3. 1 Olmos, A., López Pedret, J., & Piera, L. (2000). Acceso Vascular en Hemodiálisis. In P. Aljama, M. Arias, & F. Valderrábano, Insuficiencia Renal Progresiva (pp ). Madrid. 2 Hemphill, H., & Allon, M. (2003). How can the use of arteriovenous fistulas be increased?seminarsindialysis,16(3), pp Pile, C. (May-June de 2004). Hemodialysis vascular Access: how do practice patterns affect outcomes? Nephrology Nursing Journal, 31(3), pp

Acceso Vascular en Hemodiálisis. In P. Aljama, M. Arias, & F. Valderrábano, Insuficiencia Renal Progresiva (pp. 171-184). Madrid. 2 Hemphill, H., & Allon, M. (2003).

5 Person whit ESRD with Arteriovenous Fistula (AVF) in Hemodialysis (HD) CANNULATION OF THE AVF Disinfection of the skin first 1 ; Expertise puncture 2;3;4 ; Recognize dysfunction 3;4;5 ; Experience of team 2. TEACHING THE PATIENT WITH AVF Preserving a vascular network 1 ; Education pro-active 1 ; Education about infection 6 ; Education about thrombosis 6 ; 1 Nguyen, V. D., Grifith, C., & Treat, L. (2003). A Multidisciplinary Team Approach to Increasing AV Fistula Creation: a community-based nephrology practice experience. Nephrology News & Issues, pp Hemphill, H., & Allon, M. (2003). How can the use of arteriovenous fistulas be increased? Seminars in Dialysis, 16(3), pp Konner, K., Nonnast-Daniel, & Ritz, E. (2003). The arteriovenous fistula. Journal American Society Nephrology, pp Allon, M., & Robbin, M. (2002). Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney International, pp Pile, C. (May-June de 2004). Hemodialysis vascular Access: how do practice patterns affect outcomes? Nephrology Nursing Journal, 31(3), pp Esteves, R. (1997). A Utilização do Acesso Vascular. In P. Ponce, Acesso à Diálise: a perspectiva nefrológica (pp ). Lisboa: Quadicor.

(2003). A Multidisciplinary Team Approach to Increasing AV Fistula Creation: a community-based nephrology practice experience. Nephrology News & Issues, pp. 54-57. 2 Hemphill, H., & Allon, M. (2003).

6 Model of Care: Objectives and Areas of Intervention Dimension Anticipatory Preparation Areas of Intervention Empowerment Self-Care Surveillance Access 48h after Construction Maturation Process Hemodialysis Program Physical Examination Parameters Hemodialytic Cannulation Hematoma/Leaks Hemodynamic Monitoring Withdrawal Needles Sousa, C. N. (2009). Cuidar da Pessoa com Fístula Arteriovenosa: dos pressupostos teóricos aos contextos das práticas. Dissertação de Mestrado apresentada a Instituto Ciências Biomédicas Abel Salazar da Universidade do Porto.

Cannulation Hematoma/Leaks Hemodynamic Monitoring Withdrawal Needles Sousa, C. N. (2009).

7 Model of Care: Areas of Intervention Empowerment Self-Care Anticipatory Preparation 48h after Construction Maturation Process Hemodialysis Program Hygiene and Skin Hydration Nutrition Preservation of the Vascular Network Medicines Hydration Water Arteriovenous Fistula Immediate Care Ischemic Complications Functionality Conservation the Functionality Maturation Care Ischemic Signs Hygiene Arm Care Prior to Cannulation Intradialysis Care Withdrawal of Needles Hematoma care Interdialysis Care Sousa, C. N. (2009). Cuidar da Pessoa com Fístula Arteriovenosa: dos pressupostos teóricos aos contextos das práticas. Dissertação de Mestrado apresentada a Instituto Ciências Biomédicas Abel Salazar da Universidade do Porto.

Maturation Care Ischemic Signs Hygiene Arm Care Prior to Cannulation Intradialysis Care Withdrawal of Needles Hematoma care Interdialysis Care Sousa, C. N. (2009).

8 Model of Care: Areas of Intervention Surveillance Access Physical Examination Assess Arm Before-Construction Assess Arm After-Construction Sousa (2009) Parameters Hemodialytic Cannulation Bruising/Leaks Hemodynamic Monitoring Withdrawal Needles State Water Treatment Parameters Identify Blood Flow Select Location Cannulation Select Gauge Needles Prepare Cannulation Cannulation Technique Procedures Vasoconstriction Arterial Pressure Venous Pressure Access Flow Recirculation Rate Withdrawal Procedures Dynamic Haemostasis Time Haemostasis

Water Treatment Parameters Identify Blood Flow Select Location Cannulation Select Gauge Needles Prepare Cannulation Cannulation

9 Model of Care: from Theory to Practice - Physical Examination (arterial and venous network) - Anticipatory Preparation - Physical Examination (Functionality and presence of complications) - Maturation Process -Physical Examination (Functionality and presence of complications) - 48h after Construction - Physical Examination (Functionality and presence of complications ) - Parameters Hemodialytic - Cannulation - Hematona/Leaks - Hemodynamic Monitoring - Withdrawal Needles

(Functionality and presence of complications) - 48h after Construction - Physical Examination (Functionality and

10 Endnote Rearrange and outline the areas in which the nurse in the vascular access; You can contribute to the development of cognitive and behavioral-related vascular access; You can allow the construction of indicators sensitive to nursing care; Contributing to the visibility of obtaining health gains related to vascular access.

access; You can allow the construction of indicators sensitive to nursing care;

11 The practice of nursing care directed to the person with AVF should continually express ahigh level of quality

Stenosis Surveillance 2009

5 Diamond Patient Safety Program Stenosis Surveillance 2009 *This presentation was collaboratively developed by the Mid-Atlantic Renal Coalition (MARC) and the ESRD Network of New England for the 5-Diamond