P56
INDEPENDENT NURSE-LED VASCULAR ACCESS CLINICS: “STRIVING TO EXCEED THE
RENAL ASSOCIATION STANDARDS!”
Mr Chris Davies, Mr Justin Woolgar, Mrs Paula Davies, Miss Karen Sillick, Liz Pernas, Mrs Karen Edwards
Renal Unit, Morriston Hosptial, Swansea
Introduction: Our Renal Vascular Access Team provides a service for all haemodialysis (HD) serving a
population of 934.000. This service manages approximately 350 prevalent HD and 120 incident patients per
year. Historically the service has been recognised nationally as providing a high quality service with a high
proportion of patients receiving HD by means of an arteriovenous fistula (AVF) or arteriovenous graft (AVG).
In January 2014 the Renal Vascular Surgical Services underwent radical restructuring. As a direct result,
independent VANS Clinics were established.
Aim: To achieve RA Standards (65% incident and 85% of prevalent patients starting or dialysing via an AVF)
 Ensure timely and appropriate referral to VANS
 Prioritise patients based on clinical need
 Early identification of poor vasculature
 Enhance patient VA experience
 Reduce cancellations (Patient/Surgical)
Method: A Multispecialty / Multidisciplinary team approach, consent and IRMER training wasparamount in
establishing the VANS clinics
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VANS receive all referrals for patients requiring Vascular Access for HD or Tenckhoff catheter
insertion for Peritoneal Dialysis (PD)
Entry onto a single access waiting list
Referrals triaged by VANS
Duplex scan slots attached to clinics
Twice weekly Access clinics undertaken
Theatre date mutually agreed by patient and VANS
This unique vascular access pathway is entirely co-ordinated by the VANS.
Results: Quarterly renal vascular access audit data was analysed from January 2013 to March 2014.VANS
clinic established Jan 2014
Jan –March 2013
April-June
2013
July-Sept 2013
Oct-Dec 2013
Jan –March 2014
Incident %
22%
51%
39%
39%
67%
Prevalent %
AVF 83%
AVF 84%
AVF 83%
AVF 84%
AVF 81%
AVG 4%
AVG 3%
AVG 3%
AVG 4%
AVG 4%
38
50
56
46
59
Surgical
procedures
Discussion:
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Despite the radical changes in our service structure our numbers of surgical procedures quarterly have
increased, also encouragingly distal AVF’s predominantly being created
 % of prevalent population on HD with definitive access has slightly declined, multiple AV access
procedures and poor vasculature are known in a number of these patients.
 % of incident patients starting HD with definitive access has increased, distal AVF’s prevailing.
Take-home message
 The Independent VANS Clinics will streamline the Patient VA pathway resulting in a positive patient
outcome
 To exceed the RA standards