At Scarborough Health Network (SHN), we are dedicated to providing treatment of vascular disorders.
SHN Nephrology Program has dedicated Dialysis Vascular Access Team. Patients who require assessment, care, education, maintenance, creation, or counselling regarding dialysis vascular access i.e. Fistula, Graft, Central Venous Catheter (CVC) are referred to the Dialysis Vascular Access Team.
- The team is composed of a Nephrology Vascular Access Coordinator, Administrative Assistant, Vascular Access Registered Nurses, and Vascular Access Registered Practical Nurses who work collaboratively with the Interdisciplinary team (Vascular Surgeons, Same Day Surgery staff, Interventional Radiologists and Interventional Radiology staff, Ambulatory Patient Unit Staff and Vascular Ultrasound Department Staff). They also work collaboratively with the various team members within the Nephrology Program.
- Recognizing the ongoing growth of hemodialysis patients and the necessity to ensure patients’ “life lines” (vascular accesses) are well maintained, functional, created in a timely manner, and are chosen by the patient (where suitable and appropriate) to be either fistulas or grafts vs. central venous catheters (CVCs).
Our Vascular Access Program services include:
- There are 3 Vascular Access Clinics per week, virtual or in person where patients are seen in collaboration with the vascular nurse and the Vascular Surgeon (as per ORN guidelines). The VA clinic referrals received from Nephrologist’s office, MCKC, Home Dialysis (PD and Home Hemo), all Satellites, Hemodialysis and DMC. The Initial referrals are triaged and patients are called accordingly by VA team for access education, reinforce vein preservation and booking for vein mapping and VA Clinic. Patients who are suitable for dialysis access creation are managed in partnership with Surgery or Interventional Radiology. Post access creation, patients have routine surveillance and monitoring with access assessment by the vascular access team. Vascular access clinics also manage patients with existing dialysis accesses. Service may include; reassessment of malfunctioning dialysis access, infection, thrombosed accesses or other issues. The vascular clinic, in its assessment of patients also redirect identified patients who would benefit, are interested, and are suitable for referral (or re-referral) for home dialysis.
- In addition to coordinating dialysis vascular access creation and interventions in IR or Surgery within the clinic, the dialysis vascular access team also facilitates urgent dialysis access interventions that are identified by all hemodialysis services throughout the program including hemodialysis satellites, ICU, ER, and in-patient units. Note: Access to IR and Surgical spots are facilitated by the vascular team but also by the dedicated vascular access unit clerk who works with the respective booking clerk in each service areas by coordinating dedicated spots for dialysis vascular access within each of the respective services.
- VA team provides patients and families with comprehensive Vascular Access Education and counselling regarding hemodialysis accesses choices, benefits and disadvantages and follow-up care in VA Clinic. The team supports patients and families with Shared Care Module. Patients wishing or expressing interest in learning Shared Care self-cannulation or involvement in vascular care and management are supported and trained by VA team.
- The VA team also provides support for the front line and acts as a resource to patients and staff with the Best Practice Standards and Guidelines related to vascular access care. With the chronic, repetitive nature of hemodialysis, nurses often become lax in their vascular practice and require constant refreshing of skill sets related to infection control practices, troubleshooting, and surveillance of vascular accesses which impacts patient care and potentially increases patients’ morbidity and mortality. The Ontario Health mandates Vascular Access Educational Modules to be completed by all nurses throughout the program who care for hemodialysis patients (both home and in-centre). Any identified gaps in practice needs to be resolved to ensure adherence to expected standards of practice related to hemodialysis vascular access.
All activities provided by the vascular team, support mandates related to vascular access care, maintenance, creation, and outcomes by the Ontario Health (Ontario Renal Network). Vascular metrics and indicators are reported and benchmarked provincially.
East Wing, 1st Floor
416-438-2911 ext. 6622 / 6623 or 8376
Monday to Friday, 8 a.m. to 4 p.m.