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This blog is a networking resource for ASDIN members. It is not intended to be utilized as legal or medical advice. ASDIN offers this blog as is, without any express or implied warranties, or other assurances as to the content of the material contained herein. ASDIN assumes no responsibility for errors or omissions contained herein, or for any actions taken or damages suffered by any person on the basis of, or in reliance upon, any of the information contained herein. Cases and images should ALWAYS be stripped of any/all patient-specific information (name, DOB, MR#, etc.). Cases should be well thought out and suitable for distribution. Language usage should be polite, collegial, and professional. If it is found that a participant is not using appropriate language, that participant’s comment may be blocked.

 

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Top tags: Policy and Procedure  tunneled dialysis catheter  central vein stenosis  Coding  articles of interest  Central Stents  policies  svc thrombus  accessory veins  accessory veins/ Coils  articles of interest; RESCUE  ASC  AVF  AVF endovascular at SSM STL  case  Clot at tip of hemodialysis catheter  Consents  Conversion  Declot  dialysis staff  DIALYSIS TECHNICIAN INTERVENTIONAL SCRUB ASSISTANT  Emergency  Great Stuff !!!!  Hemodialysis Cather  HeRO  https://sites.google.com/site/abigailsarticles/may  IN jobs  MIPS QUALITY MEASURE  New KDOQI Guideline Review  Online Survey 

Trerotola Device Issues

Posted By Terry Litchfield, Friday, April 26, 2019

Is anyone having issues with the tip of the Trerotola thrombectomy device separating from the basket portion?  Over the last year, we have seen several of these occur and note the MAUDE database is reporting many of them.  The tip is often not able to be retrieved.

The manufacturing changed to Mexico and there appears to be something happening.

And of course would want to make sure that anyone seeing a product defect should report the device failure to the manufacturer.  And please report additional catheters that have the same problem.  

Would love to hear if others are seeing this.

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March 2019 Articles of Interest

Posted By Abigail Falk, Monday, March 25, 2019
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Hand-held US devices

Posted By Ryan D. Evans, Thursday, March 21, 2019

Just a general technology question for the forum.  I am ordering new ultrasound equipment for our surgery center.  There have been recent advances allowing for hand-held US technology, such as the Sonosite iVis, Android, and Ipad devices.  However, I don't see any handheld US equipment which can measure fistula flow / pulse wave doppler.  I evaluate new fistulae by US to access maturation and measure flows.

Does anyone know if there are any hand-held US devices which can measure flow?  Thanks.

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DIALYSIS TECHNICIAN AS INTERVENTIONAL SCRUB TECH

Posted By Gregg M. Gaylord, Saturday, February 23, 2019

Has anyone hired a dialysis technician as a scrub tech for their Interventional cases?  If not, what were the barriers?  If so, any comments regarding state certification/scope of practice laws, training, or other caveats?

 

Thank You

Tags:  DIALYSIS TECHNICIAN INTERVENTIONAL SCRUB ASSISTANT 

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Clot at tip of Hemo catheter

Posted By Ramesh Soundararajan, Wednesday, January 23, 2019

Wanted to pick your brain about a patient. Patient has  hemodialysis catheter and an incidental echo and a transesophageal echo cardio gram picked up a 2 cm clot at the tip of the catheter. Blood cultures are negative but infectious diseases wants to remove the catheter. It’s working fine. Concerns about removing the catheter includes dislodgment of the 2 cm clot into the lungs. One thought is to infuse TPA to try to make the clot smaller another thought is a rather drastic step to perform open heart surgery to remove the clot. It’s possible that we have inadvertently removed such catheters  and patients have done fine but having known about this problem how would you approach it. Is there any literature to support any particular action

Tags:  Clot at tip of hemodialysis catheter  Hemodialysis Cather 

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Sign-up to be a reviewer of the new KDOQI VA Guidelines

Posted By Deborah J. Brouwer-Maier, Friday, January 18, 2019

https://www.kidney.org/professionals/guidelines

Link to the National Kidney Foundation website- go to the Guidelines tab and then at the bottom of the page you can register to be a reviewer when the public review is active!  Please sign-up as these guidelines will impact your local Process of Care!!!


Tags:  New KDOQI Guideline Review 

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ultrasound in the dialysis unit for cannualiton

Posted By Deborah J. Brouwer-Maier, Thursday, December 13, 2018

Ultrasound guided cannulation is slowly becoming the standard of care outside the US.  See the 2017 guidelines on the use from Canada.  As IN’s you routinely use ultrasound imaging.  Many of you may even provide cannulation maps of a patient’s access to the dialysis unit.   The Associates program at the Feb meeting will be reviewing cannulation techniques and the issue of ultrasound imaging.  Wanted to get feedback on the interest in ultrasound guided cannulation or at least visualization before cannulation by your dialysis staff.  Do you support the idea?  Would an easy to use non-diagnostic imaging be of value to your clinics?  What about cost of the device?  The major adoption hurdle of training has already been disproven by Dr. Agarwal's study utilizing an easy to use simple point and see device.   

thanks Debbie

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Tags:  dialysis staff  ultrsound guided cannualtion 

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November 2018 Articles

Posted By Abigail Falk, Monday, December 3, 2018
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Pain in Arm with Clotted Fistula/CVC

Posted By Deborah J. Brouwer-Maier, Monday, November 5, 2018

Again, ASDIN has an opportunity to lead the way in vascular access.  Please help our colleague with her inquiry below.

 

A social worker posted on the CNSW listserv that her patient had a clotted access that has caused a lot of pain over the last few years, so we are cross-posting here. Patient now has a CVC and is getting a fistula in her other arm. The patient has swelling and pain in the arm where the fistula is clotted and has told the Social Worker that when the CVC is used it feels like her veins are being pulled out. Her surgeon has told her there isn’t a surgical option to resolve the pain she is feeling. Hate to hear of a patient having pain during each dialysis treatment.   Asking for ideas to see if you have tips or suggestions.

 

Tags:  Pain 

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Responsible Person Policy Question

Posted By Lindsay Fox, Tuesday, October 30, 2018

Please share any feedback to the following information request from an ASDIN member:

 

They would like to know what policies other centers have in place in regards to a responsible person staying in the waiting room for the duration of the patients procedure. We would like to implement this, but there are a few variables. Some patients do not have anyone and rely on share a fare or other transportation options, some have someone to drop them off, and return after procedure. 

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Endovascular AVF - WavelinQ

Posted By Alejandro C. Alvarez, Thursday, October 25, 2018

Dear Colleagues,

 

We had the Privilege to perform our first three endovascular AVF's using the wavelinQ system early this week.

 

All were an immediate technical success. We will follow the patients closely to the time of cannulation. 

 

I am very grateful to my team at the VAC and the patients that put their trust on us.

 

Here are the most meaningful images of our very first patient - these include a the final run and blood flow volume by me two days later

 

The second video is the final run of the second patient. 

 

The third is a still corresponding to the final patient.

 

Now we will follow them until the are ready to be accessed

 

Thanks,

 

Alejandro Alvarez


SSM VAC STL MO

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 Attached Thumbnails:

 Attached Files:
IMG_1924.mov (1.66 MB)

Tags:  AVF endovascular at SSM STL 

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hemostasis post endovascular interventions

Posted By Jeffrey Hoggard, Tuesday, October 23, 2018

Colleagues,

What are your methods for achieving hemostasis post sheath removal?    I use  a nylon suture and  I  write an order for  my hemostasis suture be removed at the next hemodialysis session.   It also serves as a reminder to the dialysis unit that this patient had something done to their access; maybe we should read the procedure note and find out if we should do something different.

 

One of the LDOs has adopted a policy that only allows MDs and Advanced Practitioners to remove sutures in their dialysis units.  Nurses and techs have a long history of removing sutures competently. Apparently it is a liability issue.

 

Manual compression works but is labor intensive and takes  time which is not an efficient method in a busy access center with rapid turnover.   I can remember a few patients who came back to the access center who started bleeding in the car ride home.      I suppose leaving the sutures for one or two weeks until the rounding MD or AP can remove the suture in the dialysis unit is safe but that  does not seem ideal. Does anyone use absorbable sutures  or skin glue?    

 

Jeff Hoggard

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Intraoperative Monitoring of Access Sites

Posted By Administration, Wednesday, October 10, 2018

 

ASDIN Members - We have received an inquiry from a CRNA on grafts clotting during surgery..  Please assist by responding to this post.

 

 

From Michael-Malachi Cohen CRNA, MSN

We have had at least 3 Dialysis grafts fail during surgery.  The cases were at least 4 hours each and with the patient in Trendelenburg positioning.  None of the cases involved direct pressure on the graft sites.  If possible please supply any information, algorithm, or standard of care that you have available on intraoperative monitoring of these access sites. 

 

Thank you for your time and effort as you look into this for our facility. 

 

Malachi

 

 

 

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C arm advice

Posted By Dany Issa, Friday, October 5, 2018

 

 

Hi all;

 

Our institution is looking into upgrading our current retiring C arm.

 

Has anybody upgraded such equipment in recent years ? any advice ?

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September 2018 Articles of Interest

Posted By Abigail Falk, Tuesday, September 25, 2018

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