Szymon Brzósko
@brzosko.bsky.social
nephrology, transplantation, dialysis, MD, PhD, assoc. prof./ my own opinions | Bialystok, Poland
📚 Based on:
"Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future"
Kidney Medicine, 2024
t.co/UKjAyORInb
16/16
"Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future"
Kidney Medicine, 2024
t.co/UKjAyORInb
16/16
https://www.kidneymedicinejournal.org/article/S2590-0595(24)00082-7/fulltext
t.co
November 27, 2024 at 9:03 AM
📚 Based on:
"Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future"
Kidney Medicine, 2024
t.co/UKjAyORInb
16/16
"Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future"
Kidney Medicine, 2024
t.co/UKjAyORInb
16/16
🔑 Take-Home Message:
"The best time to plan vascular access was months ago. The second best time is now."
Share this thread with your colleagues!
#VascularAccess #KidneyHealth #MedEd
15/16
"The best time to plan vascular access was months ago. The second best time is now."
Share this thread with your colleagues!
#VascularAccess #KidneyHealth #MedEd
15/16
November 27, 2024 at 9:03 AM
🔑 Take-Home Message:
"The best time to plan vascular access was months ago. The second best time is now."
Share this thread with your colleagues!
#VascularAccess #KidneyHealth #MedEd
15/16
"The best time to plan vascular access was months ago. The second best time is now."
Share this thread with your colleagues!
#VascularAccess #KidneyHealth #MedEd
15/16
🎯 Goals for Success:
• Catheter-free initiation
• Long-term access survival
• Reduced complications
• Better patient outcomes
14/16
• Catheter-free initiation
• Long-term access survival
• Reduced complications
• Better patient outcomes
14/16
November 27, 2024 at 9:03 AM
🎯 Goals for Success:
• Catheter-free initiation
• Long-term access survival
• Reduced complications
• Better patient outcomes
14/16
• Catheter-free initiation
• Long-term access survival
• Reduced complications
• Better patient outcomes
14/16
💪 Patient Education Must Include:
• Access care
• Arm exercises
• Warning signs
• Emergency contacts
Empower your patients!
13/16
• Access care
• Arm exercises
• Warning signs
• Emergency contacts
Empower your patients!
13/16
November 27, 2024 at 9:03 AM
💪 Patient Education Must Include:
• Access care
• Arm exercises
• Warning signs
• Emergency contacts
Empower your patients!
13/16
• Access care
• Arm exercises
• Warning signs
• Emergency contacts
Empower your patients!
13/16
📱 Monitoring Schedule:
• Weekly checks during maturation
• Physical examination
• Ultrasound when needed
• Flow measurements
Stay vigilant!
12/16
• Weekly checks during maturation
• Physical examination
• Ultrasound when needed
• Flow measurements
Stay vigilant!
12/16
November 27, 2024 at 9:03 AM
📱 Monitoring Schedule:
• Weekly checks during maturation
• Physical examination
• Ultrasound when needed
• Flow measurements
Stay vigilant!
12/16
• Weekly checks during maturation
• Physical examination
• Ultrasound when needed
• Flow measurements
Stay vigilant!
12/16
👥 Team Approach Required:
• Nephrologist
• Vascular surgeon
• Access coordinator
• Dialysis staff
• Primary care physician
Success needs collaboration!
11/16
• Nephrologist
• Vascular surgeon
• Access coordinator
• Dialysis staff
• Primary care physician
Success needs collaboration!
11/16
November 27, 2024 at 9:03 AM
👥 Team Approach Required:
• Nephrologist
• Vascular surgeon
• Access coordinator
• Dialysis staff
• Primary care physician
Success needs collaboration!
11/16
• Nephrologist
• Vascular surgeon
• Access coordinator
• Dialysis staff
• Primary care physician
Success needs collaboration!
11/16
⚠️ Common Mistakes:
• Waiting too long
• Skipping vascular mapping
• Ignoring early signs of failure
• Poor monitoring during maturation
10/16
• Waiting too long
• Skipping vascular mapping
• Ignoring early signs of failure
• Poor monitoring during maturation
10/16
November 27, 2024 at 9:03 AM
⚠️ Common Mistakes:
• Waiting too long
• Skipping vascular mapping
• Ignoring early signs of failure
• Poor monitoring during maturation
10/16
• Waiting too long
• Skipping vascular mapping
• Ignoring early signs of failure
• Poor monitoring during maturation
10/16
🔄 Progression of Care:
Week 1: Initial evaluation
Week 2-3: Vascular mapping
Week 4: Surgical consult
Week 6-8: Access placement
Months 4-6: Maturation
9/16
Week 1: Initial evaluation
Week 2-3: Vascular mapping
Week 4: Surgical consult
Week 6-8: Access placement
Months 4-6: Maturation
9/16
November 27, 2024 at 9:03 AM
🔄 Progression of Care:
Week 1: Initial evaluation
Week 2-3: Vascular mapping
Week 4: Surgical consult
Week 6-8: Access placement
Months 4-6: Maturation
9/16
Week 1: Initial evaluation
Week 2-3: Vascular mapping
Week 4: Surgical consult
Week 6-8: Access placement
Months 4-6: Maturation
9/16
💡 Smart Planning:
1. Early nephrology referral
2. Vascular mapping
3. Patient education
4. Regular monitoring
5. Timely surgical consultation
8/16
1. Early nephrology referral
2. Vascular mapping
3. Patient education
4. Regular monitoring
5. Timely surgical consultation
8/16
November 27, 2024 at 9:03 AM
💡 Smart Planning:
1. Early nephrology referral
2. Vascular mapping
3. Patient education
4. Regular monitoring
5. Timely surgical consultation
8/16
1. Early nephrology referral
2. Vascular mapping
3. Patient education
4. Regular monitoring
5. Timely surgical consultation
8/16
🚩 Red Flags for Early Referral:
• Rapid eGFR decline
• Resistant hypertension
• Uncontrolled diabetes
• Advanced age with CKD
Don't wait for crisis!
7/16
• Rapid eGFR decline
• Resistant hypertension
• Uncontrolled diabetes
• Advanced age with CKD
Don't wait for crisis!
7/16
November 27, 2024 at 9:03 AM
🚩 Red Flags for Early Referral:
• Rapid eGFR decline
• Resistant hypertension
• Uncontrolled diabetes
• Advanced age with CKD
Don't wait for crisis!
7/16
• Rapid eGFR decline
• Resistant hypertension
• Uncontrolled diabetes
• Advanced age with CKD
Don't wait for crisis!
7/16
📈 Success Rates with Proper Timing:
• 88% catheter-free starts with well-timed AVF
• 48% with AVG
• Timing is everything!
6/16
November 27, 2024 at 9:03 AM
📈 Success Rates with Proper Timing:
• 88% catheter-free starts with well-timed AVF
• 48% with AVG
• Timing is everything!
6/16
🎯 Pro Tip: The "Crash-Landing" Problem
• Almost 50% of US patients start dialysis unprepared
• No permanent access in place
• Results in avoidable catheter use
We can do better!
5/16
November 27, 2024 at 9:03 AM
🎯 Pro Tip: The "Crash-Landing" Problem
• Almost 50% of US patients start dialysis unprepared
• No permanent access in place
• Results in avoidable catheter use
We can do better!
5/16
⏰ Maturation Times:
• AVF: 4-6 months
• Standard AVG: 10-14 days
• Early cannulation AVG: 24-72 hours
Know these timelines for better planning!
4/16
November 27, 2024 at 9:03 AM
⏰ Maturation Times:
• AVF: 4-6 months
• Standard AVG: 10-14 days
• Early cannulation AVG: 24-72 hours
Know these timelines for better planning!
4/16
📊 Timing Guidelines for AV Access:
• Evaluate when eGFR approaches 15-20 mL/min
• Plan AVF 4-6 months before expected dialysis
• Consider AVG 2-3 weeks before need
3/16
• Evaluate when eGFR approaches 15-20 mL/min
• Plan AVF 4-6 months before expected dialysis
• Consider AVG 2-3 weeks before need
3/16
November 27, 2024 at 9:03 AM
📊 Timing Guidelines for AV Access:
• Evaluate when eGFR approaches 15-20 mL/min
• Plan AVF 4-6 months before expected dialysis
• Consider AVG 2-3 weeks before need
3/16
• Evaluate when eGFR approaches 15-20 mL/min
• Plan AVF 4-6 months before expected dialysis
• Consider AVG 2-3 weeks before need
3/16
🔑 Key Question: When should we plan and place vascular access for hemodialysis?
Short answer: Predialysis placement of adequate access directed by an orderly planned process, which provides sufficient lead time for maturation.
2/16
Short answer: Predialysis placement of adequate access directed by an orderly planned process, which provides sufficient lead time for maturation.
2/16
November 27, 2024 at 9:03 AM
🔑 Key Question: When should we plan and place vascular access for hemodialysis?
Short answer: Predialysis placement of adequate access directed by an orderly planned process, which provides sufficient lead time for maturation.
2/16
Short answer: Predialysis placement of adequate access directed by an orderly planned process, which provides sufficient lead time for maturation.
2/16
Ha! Thank you. Primary results seemed to be promising … have seen the paper, after a few uses no OR time usage prol. and less incidents
November 21, 2024 at 7:00 AM
Ha! Thank you. Primary results seemed to be promising … have seen the paper, after a few uses no OR time usage prol. and less incidents
Instructive & interesting, thx!
November 20, 2024 at 7:45 PM
Instructive & interesting, thx!
Yes, actually neither me strong in pathology ;) - but diseases related to other options not very much clinically associated with myopathy what is the case for glycogen storage disease type V :)
November 19, 2024 at 7:32 PM
Yes, actually neither me strong in pathology ;) - but diseases related to other options not very much clinically associated with myopathy what is the case for glycogen storage disease type V :)
