CARE
CARE FOR
FOR THE
THE PERSON
PERSON WITH
WITH
ARTERIOVENOUS
ARTERIOVENOUS FISTULA
FISTULA
6th
6th Congress
Congress of
of Nephrology
Nephrology in
in Internet
Internet
15
15--30
30 November
November 2011
2011
ARTERIOVENOUS
ARTERIOVENOUS FISTULA
FISTULA
Clemente
Clemente Sousa
Sousa
1
1
;;
João
João Apóstolo
Apóstolo
2
2
; Maria Henriqueta Figueiredo
; Maria Henriqueta Figueiredo
1
1
; Manuela Martins
; Manuela Martins
1
1
1
1
Escola Superior de Enfermagem do Porto, Porto, Potugal;
2
Escola Superior de Enfermagem de
Coimbra, Coimbra, Portugal
Model
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
;
800 000 people with Chronic Kideney Disease in Portugal
2
;
800 000 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
;
1Schoolwerth, 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. 2Pereira, P. (2008). Em Portugal existem 14 mil pessoas em diálise ou transplante. Saúde Pública, 22-23.
3Sociedade Portuguesa Nefrologia, S. (2005). Relatório Anual 2004.Lisboa.
4Matesanz, R. (2006). El milagronde los trasplantes de la donación órganos a las células madre.Madrid: Esfera de los Libros.
Practice Care of People with End Stage
Renal Disease (ESRD)
…
…Century
Century XX…
XX…
Until the late 50
50 and 60
After the 60
Biomedical Model
Relief of
Symptoms
Until the late 50
Monitor
50 and 60
Realization of the
treatment of HD
After the 60
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.
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
.
1Olmos, A., López Pedret, J., & Piera, L. (2000). Acceso Vascular en Hemodiálisis. In P. Aljama, M. Arias, & F. Valderrábano,Insuficiencia Renal Progresiva(pp. 171-184). Madrid.
2Hemphill, H., & Allon, M. (2003). How can the use of arteriovenous fistulas be increased?Seminars in Dialysis , 16(3), pp. 214-216.
Person whit ESRD with Arteriovenous Fistula
(AVF) in Hemodialysis (HD)
Disinfection of the skin first
1
;
Expertise puncture
2;3;4
;
Preserving a vascular network
1
;
Education pro-active
1
;
CANNULATION OF THE AVF
TEACHING THE PATIENT WITH AVF
Expertise puncture
2;3;4
;
Recognize dysfunction
3;4;5
;
Experience of team
2
.
Education pro-active
1
;
Education about infection
6
;
Education about thrombosis
6
;
1Nguyen, 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. 54-57.
2Hemphill, H., & Allon, M. (2003). How can the use of arteriovenous fistulas be increased?Seminars in Dialysis, 16(3), pp. 214-216. 3Konner, K., Nonnast-Daniel, & Ritz, E. (2003). The arteriovenous fistula.Journal American Society Nephrology, pp. 1669-1680.
4Allon, M., & Robbin, M. (2002). Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions.Kidney International, pp. 1109-1124. 5Pile, C. (May-June de 2004). Hemodialysis vascular Access: how do practice patterns affect outcomes?Nephrology Nursing Journal, 31(3), pp. 305-308. 6Esteves, R. (1997). A Utilização do Acesso Vascular. In P. Ponce,Acesso à Diálise: a perspectiva nefrológica(pp. 29-38). Lisboa: Quadicor.
Model of Care:
Objectives and Areas of Intervention
Anticipatory Preparation
48h after Construction
Maturation Process
Empowerment Self-Care
Dimension
Surveillance Access
Physical Examination
Parameters Hemodialytic
Cannulation
Hemodynamic Monitoring
Hematoma/Leaks
Withdrawal Needles
Hemodialysis Program
Areas of
Intervention
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.
Model of Care:
Areas of Intervention
Anticipatory Preparation
Empowerment Self-Care
Immediate Care
Hygiene and Skin Hydration
Nutrition
Preservation of the Vascular Network
Medicines
Hydration Water
Arteriovenous Fistula
48h after Construction
Maturation Process
Hemodialysis Program
Functionality
Ischemic Complications
Immediate Care
Conservation the Functionality
Hygiene Arm
Ischemic Signs
Maturation Care
Care Prior to Cannulation
Intradialysis Care
Hematoma care
Withdrawal of Needles
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.
