Increasing Individualization of Patient Care Plans For Hemodialysis Vascular Access
Individualized patient care plans are becoming an increasingly common way of viewing the relationship between a patient and their healthcare team, impacting all medical disciplines including hemodialysis.
It’s a model that emphasizes developing an individualized, comprehensive care plan that accounts for the full picture of the patient’s needs and preferences – decision-making becomes more of a partnership between patient and care team.
The latest National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative’s guidelines, for example, focus heavily on the benefits of taking a patient-focused approach with evidence-based guidelines for hemodialysis vascular access.
Read on to learn more about what these guidelines mean and the measurement tools that can help support these goals.
Patient-Focused Vascular Access and Life Plans
There are several aspects to determining a patient’s “right access, at the right time, for the right reasons.” Some of the elements for patient-focused hemodialysis include:
- Developing an End-Stage Kidney Disease (ESKD) Life-Plan that considers the patient’s needs and preferences around vascular access.
- Planning for possible complications and revisions of the current access configuration.
- Considering how vascular access choice, arteriovenous (AV) fistulas and grafts, and central venous catheters fit into the overall picture, both short-term and long-term.
- Maintaining consistent monitoring and surveillance for detection of access dysfunction
While the Life Plan should be reviewed annually, the patient’s vascular access should be reviewed at least quarterly and after any access intervention.
The One Minute Check, developed as part of the Fistula First initiative, includes guidelines on how to assess patients with a catheter, AVF or AVG. It should be performed before catheter connection or access cannulation.
To detect access dysfunction, physical monitoring can be complemented by surveillance measurements such as Delivered Flow, Recirculation, and Access Flow.
A Patient Case: Individualized Care Plan For a 45-Year-Old Male
In this example, a patient had an acute start with no prior treatment of chronic kidney disease. As a result, he had an urgent placement of an HD catheter for hemodialysis. He lives alone and lacks family support.
His Life Plan includes HD outpatient therapy and evaluations for a kidney transplant. He would like to be placed on the transplant list, if appropriate. In terms of dialysis access, the patient requires a tunnel cuffed catheter and a radiocephalic arteriovenous fistula (RC-AVF). Vascular access needs to be maintained but flexibility is required.
With these parameters in mind, it’s possible to meet his medical needs while still following a patient-focused approach with the right tools.
Flow measurement tools can be used for surveillance with patients like this in line with his individualized care plan. For example, Transonic’s HD03 Hemodialysis Device can be optimized for a catheter connection configuration to measure the delivered flow and recirculation, allowing for adjustments to the patient’s treatment on the spot. It can be used in an acute hospital setting or outpatient HD facility, depending on which treatment path best fits the patient’s life plan.
To measure is to know. And to know is to offer an improved patient experience.