How to be a good access interventionist

A few words for interventional nephrologist colleagues
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Be a Competent Vascular Access Interventionist

A Few Words for Interventional Nephrologist Colleagues

Interventional nephrology is a relatively new subspecialty that has emerged in recent years. Among the procedures commonly practiced by interventional nephrologists, hemodialysis access management comprises a significant portion. A good vascular access is essential for successful renal replacement treatment and quality dialysis care.

With the advancement of interventional techniques and development of related medical devices, the treatment for dysfunctional dialysis access has evolved from traditional open surgery to minimally invasive vascular interventions. As an interventional nephrologist, you should be adept at handling vascular access issues in a less invasive way. Here is some advice from a senior access surgeon.

Be Passionate

The goal of performing interventions on dialysis access is to correct the failing access and make it functional again with minimal intervention cost. One must always consider the quality of life of patients. Performing interventions ourselves instead of referring patients to others, such as vascular surgeons, is crucial. We believe in the benefits of minimally invasive vascular interventions and the ability of interventional nephrologists to perform these procedures effectively and affordably.

Remember that "minimal invasiveness" is the gold standard in all procedures. While it's impossible to access the human vascular system and fix lesions without creating any wounds or bleeding, our responsibility is to minimize invasiveness. Often, vascular interventions are preferable to traditional open surgery in terms of reducing complications and improving quality of life.

As an interventionist, be passionate about "minimally invasive" techniques. Trust in your training and design minimally invasive treatments for your patients' dialysis access problems.

Learn Fundamental Skills

Vascular intervention for dialysis access involves treating lesions using diagnostic angiography and interventional radiology. It may be performed in a fixed angiography room or an operating room with a mobile C-arm unit. Although interventional radiology training is not typically part of nephrology training, there are essential skills and knowledge areas to master before performing clinical treatments.

• Radiation safety
• Sterile technique
• Contrast agents
• Interventional tools (wires, catheters, balloons, stents, etc.)

Additionally, understanding access creation/revision and access monitoring/surveillance is crucial. Familiarity with clinical guidelines on dialysis access interventions is also important.

Keep Up-to-Date

Medical knowledge for dialysis patients has grown exponentially in recent decades. Interventional techniques have also rapidly evolved. With new interventional equipment introduced annually, keeping up-to-date with the latest advancements is vital.

Stay informed through peer-reviewed journals, annual scientific meetings, and international symposiums on endovascular therapies. These are valuable sources for the latest knowledge and techniques in dialysis intervention.

Practice, Practice, Practice

Hemodialysis access management is a routine part of an interventional nephrologist's clinical work. Continuous practice is essential for becoming a competent vascular access interventionist. In our institution, surgical fellows must assist or perform at least a thousand vascular access interventions during their two-year training to qualify as independent surgeons.

No procedure is perfect, but practice brings us closer to perfection. Through consistent practice, interventionists can improve workflow, reduce operation time, and minimize patient stress and radiation exposure. Experience from various clinical scenarios helps refine procedures toward minimal invasiveness and zero complications.

Teamwork

Patient care involves teamwork. While nephrologists adopt interventional techniques to enhance dialysis access care, it is impossible to provide complete care alone. Permanent access creation remains a surgical task, and surgical backup is necessary to ensure patient safety.

Maintain good relationships and communication with surgical colleagues. Establishing a vascular access intervention team with several interventionists, knowledgeable nurses, and radiology technicians is essential for providing timely and quality care. The team should have its angiography facility and offer urgent services at least six days a week for acute access dysfunction cases.

Spread the concept and techniques of vascular access intervention within your unit to create a patient-friendly environment for dialysis patients. An institution without a robust teamwork mechanism cannot provide reliable care for patients with dialysis access problems.

Any question , feel free to ask me 
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