Transonic has long been proud of Debbie Brouwer-Maier, RN, our own hemodialysis expert. Debbie’s career has spanned four decades, during which she has held many positions within the hemodialysis world, in the clinical trenches and out, including seats within some of the most influential organizations in hemodialysis such as ASDIN, VASA and KDOQI. She has participated in countless conferences and publications, including, most recently, a chapter she wrote for an upcoming book. In “Career Pathways into Nephrology Nursing,” Debbie expounds on a topic that is very important to her, and she says should be important to every person in hemodialysis, whether clinician or patient. Join us in this interview to find out why…
Q&A with Debbie Brouwer-Maier, Dec 8, 2025: “One Chapter at a Time”
Q: Debbie, thanks for taking the time to talk with us. So, this isn’t the first hemodialysis publication you’ve been involved in, but we understand this is a special one. What made you want to contribute to this book in particular?
A: Thanks, it’s good to be here, and the answer is pretty simple: this book includes the role of VAC. Outside of the US, the position is well-regarded, especially in Canada, but now that the Fistula First Project has come to a close, many US clinics don’t see the role of the VAC as important, though it’s actually essential. This book is aimed at people looking to become a nurse, so we want to encourage them to go into this, since students in the US don’t even know that VAC is a possible career path.
Q: So writing a book, or participating in writing a book is a large undertaking. Tell us a little about what it’s like.
A: The hardest part is actually the literature. Very few papers have been written that define the VAC role or its contribution to hemodialysis, so the most demanding part of the writing wasn’t the writing at all, but the research. Even the KDOQI didn’t have high-level support info. So there just aren’t well-documented standards to pull from when writing about this.
Q: So is it your hope that this book may help to create some of that standardization?
A: Yes, Hopefully this will be involved in standardization. The chapter includes graphics of the access plan and life plan. Contingency Plan is the care and maintenance for the vascular access, which includes monitoring and surveillance. The VAC is critical to the monitoring and surveillance because without a VAC, one person does the Transonic measurement, another person schedules, another person communicates with the nephrologist, and communication breakdown is always possible because no one is coordinating all the needs that surround the access maintenance. The VAC can take all of these responsibilities, unifying access care. This chapter calls out the role and goals the VAC would have in each stage of the access plan.
Q: The book is titled “Carrer Pathways into Nephrology Nursing.” Does this reflect your personal journey?
A: Yes, it represents the overarching resiliency of what a VAC can do. When I began nursing, the role didn’t exist. The KDOQI guidelines came into existence in 1997, encouraging a multidisciplinary team, and the VAC is an essential part of that team. So overall, it reflects the evolution of the role from non-existence to making acceptance headway across the globe.
Q: I know that you consider every clinician’s role in medicine to be invaluable, but you also consider the role of the VAC to be uniquely pivotal?
A: Yes! The VAC is a much-needed specialty, because of the many layers of knowledge that VAC’s bring to the table. They understand physiology, understand what can lead to access dysfunction. VAC’s can (and do) learn those things to a deeper level than typical dialysis staff who have other responsibilities.
Vascular access is used in the clinic, but the interventions needed to maintain it aren’t part of the care team’s direct activities. It’s great to have someone who can coordinate, be a liaison of sorts, help the nephrologist identify when there might be an intervention needed to care for the access. There’s a lot of communication and record transfer that’s needed to keep the access healthy. Without a VAC, most clinics don’t have a dedicated person to do this.
Q: You have forty years of experience with hemodialysis, and you’ve chosen to work with Transonic’s HD technology. Can you explain why?
A: So it goes back to when Transonic’s HD monitor was invented. We were working on the first KDOQI, creating the standards we’ve been discussing. The Transonic device gave us something we’d never had before: the ability to look at the function of the accesses. With Transonic, we could trend access flow, so for the first time, we could plan interventions ahead of time. We used to have to wait until the access clotted, and that’s how we exhausted access points. With Transonic’s technology, we can extend the time that each access is viable.
Q: You and I have discussed mentoring before in this blog. But with the length of your career and the positive effects you’ve had on hemodialysis patients and clinicians alike, I think we’re talking about more than mentorship. I think we’re talking about legacy. So this is a big question, but how do you see your legacy?
A: Breaking barriers. When I began, nurses weren’t really included in access care. It was all doctors dealing with doctors. But now we’ve gotten the nurses involved by showing the value that the care team can bring to the patient-care discussion. For example, they can advocate for the patient in a more direct way because they deal with the patient personally and frequently.
Furthermore, there was an intellectual bias that nurses couldn’t understand the complex issues of access creation and pathology/interventions. We’ve broken that incorrect stereotype. I had mentors who helped in the process, and we won seats at the table at the national level with the societies like ASDIN, which now allows nurses to be members, though still not equal members with doctors. VASA on the other hand, does grant equal memberships to nurses.
So the legacy is breaking through the incorrect biases and invalid stereotypes that nurses can’t achieve a knowledge base deep enough to help guide care, do research, or bring the patient’s voice to light.
As nurses, we have done all of those things with great skill and success.
Q: So I understand that Transonic has a small Christmas gift for anyone considering going into hemodialysis nursing, or nursing in general, and it’s related to this chapter?
A: Yes, we’re happy to offer our VAC handbook to any nurse, hemodialysis clinician, VAC, or anyone with interest in those fields. You are welcome to download it for yourself or as a gift for someone else. It includes the life plan concept, and explains the roles of the VAC in that life plan. It highlights how the life plan and access plan support the best possible patient care, and gives examples of how the VAC can advocate and provide communication and collaboration. Afterall, Transonic wants what everyone in the hemodialysis sphere wants—the best possible care for the patients’ accesses, and thereby the best possible outcomes for the patients.
Thanks for reading,
Transonic Systems, Inc
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