Chronic HD patients, 81% with AVF and 19% via CVC (according to March 2016 CUH total CVCs).

Optimum management of vascular access is vital for the survival of HD patients. It is vital that these AVFs are matured, well maintained and continue to function efficiently throughout a patient’s time on HD.

Complications of AVF

• Infections
• Stenosis
• Thrombosis
• Steal Syndromes
• Bruises and infiltration
• Prolonged waiting time of AVF cannulation
• Failed AVF-post operation
• Painful AVF from cannulations
• Reduced access flow

Apart from infections, stenosis, steal syndromes and thrombosis, the common complications of AVF includes bruises and infiltrations related to failed cannulation, prolonged waiting time of cannulation due to underdeveloped AVF, failed AVF due to poor surgical technique during operations. Many patients also report pain of the AVF access site during cannulation. Reduced access flow – due to calcified arteries/veins leading to thrombosis. There are limited treatment options for patients presenting with these problems.

Protocol

A protocol has been developed by the renal team at CUH based on the recommendations from the Renal Association standard Guidelines in the UK, Vascular Access Guidelines under 6.2.

• Post AVF creation 
• Steal Syndrome 
• Low access flow 
• AVF bruises due to infiltration from previous cannulation
• Painful AVF cannulation site

Exclusions

Partially clotted AVF – confirm clots via ultrasound and aspiration of clots during cannulation

Skin infections

Pilot study

Case study: AVF maturation period using FIR Therapy

5 patients were recruited: 1 control patient 

Criteria

• Haemodialysis using CVC as access for HD
• First AVF creation: radio-cephalic AVF
• Age group: 18 to 60
• Non diabetic 
  

Methodology/Measurement

Done by a vascular access link nurse

Ultrasound measurement using the standard sonosite machine

Protocol: Measure the size of the veins (both arterial and venous access site) arterial access site: 5 cm after the anastomosis and venous access site measured 10 cm away from the arterial access site. Measurement done in every dialysis session.

Result (On-going study)

Conclusion

We have found FIR therapy is beneficial for the maturation of AVFs, particularly in patients with challenging access.

FIR is a safe and effective treatment of problems such as AVF bruises and haematoma (through its direct anti-inflammatory properties).

Author's:

• Regin Lagaac

Site:

• Cambridge University Hospitals

Presented at the 2019 VASBI Conference.