TITLE:  Impact of a trained vascular access coordinator on a vascular access program in India.

BACKGROUND: Native AV fistulas are the ideal access for hemodialysis but require monitoring and multiple interventions in some patients to keep them functioning. The aim of the study was to assess the impact of the appointment of a trained vascular access coordinator (VAC) for fistula monitoring, on the evolution of the vascular access program at our institute.

METHOD: Data was retrieved from the departmental database for the baseline year 2014 and compared with the data from 2018. Initial review showed that appointment of the VAC in 2015 resulted in a steady increase in the number of AV fistula interventions over 2 years to a plateau in 2018 which was chosen as the comparison year. The number of AVF's created, number of salvage procedures performed, and follow-up data were compared. Other parameters like number of operation theatre hours, surgeons, and nursing staff remained constant during this period.

RESULT: Total numbers of AVFs increased from 511 to 713 (39.3%). The number of follow-up visits to surgeons reduced from an average of 4-0.25 visits per patient during this period. Follow up Doppler examinations increased from 761 to 1296 (70%) indicating improved follow up. The salvage procedures increased from 44 to 161 (272%) with early detection of fistula dysfunction. Primary and secondary patency rates of 86% and 92% at 3 months could be achieved whereas limited follow-up data was available for 2014.

CONCLUSION: Appointment of trained VAC increased the number of vascular access procedures, improved follow-up care, and led to early detection and intervention for access dysfunction while reducing the workload of surgeons.

SOURCE: Pundir E, Sharma A, Singh S, et al. Impact of a trained vascular access coordinator on a vascular access program in India[J]. J Vasc Access, 2021 :11297298211001612. DOI: 10.1177/11297298211001612.

背景：自体动静脉内瘘是血液透析的理想通路，但在一些患者中，需要进行监测和多种干预以保持其功能。这项研究的目的是评估任命一名经过培训的血管通路协调员（VAC）进行内瘘监测对我们研究所血管通路计划演变的影响。

方法：从中心数据库中检索2014年基准年的数据，并将其与2018年的数据进行比较。初步回顾，自2015年任命VAC以来，AV内瘘干预次数稳步增加，2年内达到高峰（2018年）。同时比较了AVF的建立数量，紧急补救的数量以及后续数据。在此期间，其他参数（如手术室小时数，外科医生和护理人员）保持不变。

结果：AVF总数从511增加到713（39.3％）。在此期间，对外科医生的随访次数从每位患者平均4次下降到0.25次。随访多普勒检查从761例增加到1296例（70％），表明随访情况有所改善。早期发现内瘘功能障碍的补救行为从44增至161（272％）。在3个月时，初次和二次通畅率可达到86％和92％，而2014年的随访数据有限。

结论：任命经过培训的VAC可以增加血管通路操作的数量，改善后续护理，并导致对通路功能障碍的早期发现和干预，同时减少外科医生的工作量。

启发：血管通路协调员承担起了AVF院外延伸护理服务，协助管理患者的“生命线”，为通路医生与患者搭建桥梁。