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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  Consents  Conversion  Declot  dialysis staff  Emergency  Great Stuff !!!!  HeRO  https://sites.google.com/site/abigailsarticles/may  IN jobs  MIPS QUALITY MEASURE  New KDOQI Guideline Review  Online Survey  Pain  PD catheter PERITONEOGRAM  Pennsylvania 

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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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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use of clamp for hemostasis post dialysis

Posted By Shahriar Moossavi, Friday, September 14, 2018

Hope everyone is well.

I would like to know what is the consensus on using clamps for hemostasis post dialysis cannulation:

 

1) No clamps. Only manual compression after removal of the dialysis needles

2) One clamp at a time

3) remove both needles and use two clamps

4) use clamps for fistula but no clamps for AVG 

 

 

Thanks,

 

 

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August Articles of Interest

Posted By Abigail Falk, Thursday, August 30, 2018
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MIPS Venous Thromboembolism and Antibiotic Prophylaxis

Posted By Gregg M. Gaylord, Saturday, August 25, 2018

 

For CPT codes 36902 and 36905, quality measures listed for MIPS are:

 

measures   FLUORO recorded with dose: 145

                    Venous Thromboembolism Prophylaxis:  23

                    Antibiotic Prophylaxis:   21

                     Calculation of surg risk:  358

 

Measures 23 and 21 seem irrelevant for 36902 and 36905.  If you use these measures for these cases, you will check off "exempt" for each case you don't use prophylaxis.  You can get points for this, but in order to score a full number of points, you have to do at least 20 cases of prophylaxis for each measure.  Is anyone actually doing this?  Does anyone know why these measures are even linked to these CPT codes?  We have been in touch with CMS and they are silent on "why".  They simply state how they are used and how they score.

 

I routinely use 145 and 358.  But I need he other two measures to achieve compliance with the number of required measures.

 

Thoughts?

 

Thanks,

GMGaylord MD FSIR

Tags:  MIPS QUALITY MEASURE 

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High Level disinfection and Joint Commission Accreditation

Posted By Naveen K. Atray, Tuesday, August 21, 2018

Colleagues,

As some of you may know, CMS now requires High Level Disinfection (HLD)for all Medicare deemed ASC.

Failure to meet this requirement is considered a condition level deficiency.

In the context of Vascular Centers, this means HLD of ultrasound probes.

Only practical solution we have come up with is to consider Trophon since use of glutaraldehyde is impractical in our setting.

However, Trophon's list of compatible ultrasound probes is limited and may not include for example MindRay which is what we use at our Center.

I wonder if any one else is faced with similar challenge and what they're doing about it. Thank you in advance for your feedback.

 

Naveen Atray

Sacramento, CA

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Hiring an Interventional Nephrologist

Posted By Abraham Thomas, Thursday, August 9, 2018
My practice is looking to add a trained IN doctor to an existing center, preferably a graduating fellow - any good resources to suggest ? Thank you

Tags:  IN jobs 

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