One of the most important things a dialysis patient must care for is their vascular access since without this they cannot receive adequate treatment. Many patients receive treatment in dialysis centers where it is expected they will routinely have their vascular access assessed and evaluated in a variety of ways. Educating patients about signs and symptoms of vascular access complications is one of the many ways dialysis providers can help empower their patients.
Physical exam is a hands-on assessment and can identify complications such as changes in thrill or bruit, swelling of the access extremity, or formation of aneurysms. Patients can be taught how to perform portions of the physical exam such as a simple arm elevation test if they have an AV fistula or how to feel for the thrill throughout the access and that any changes should be reported to their dialysis care givers. Adequacy labs such as Kt/v or URR are also drawn monthly and used to help monitor for access complications. Patients who are able should have their labs reviewed with them as well as made aware of what goals they are trying to meet and what affects them reaching those goals. One reason adequacy goals are not met is because the vascular access has developed stenosis which is preventing the patient from receiving adequate dialysis treatment.
Additionally, surveillance testing such as Vasc-Alert is another tool that can help proactively identify vascular access complications. Vasc-Alert has a clinically validated, access risk score that is simple for patients to understand because it ranks the vascular access and its risk of complication on a 1-10 scale. Patients with multiple clinical indicators in their Vasc-Alert surveillance data will score higher indicating their access is at a high risk of complication and should be referred for further evaluation. Teaching patients to identify signs of complication and reviewing their access risk score with them can help empower them to proactively identify problems.
Empowering our patients by including them in the care of their vascular access by teaching them how to perform physical assessments or interpret labs and surveillance reports can lead to improved outcomes and quality of life.