A dedicated renal vascular access nurse (VAN) role was introduced in a large dialysis service in 2005. To evaluate the impact of the role, vascular access outcomes for arteriovenous fistula (AVF) at first dialysis, vascular catheter use, and access thrombosis and infection rates were benchmarked to national and international guidelines.
At the end of 2014, a retrospective audit was conducted on the vascular access outcomes data. The percentage of patients with a functioning AVF on dialysis commencement was 61% compared to 46% nationally. Prevalent data reveal that 92% of patients were using an AVF or AV graft for haemodialysis, surpassing the national benchmark of 85%. The AVF thrombosis rate was 0.09 episodes/patient year compared to the recommended rate of <0.25 episodes/patient year at risk. The recommended vascular catheter-related bacteraemia rate of <1.5 episodes/1000 catheter days was surpassed at 0.29 episodes/1000 catheter days, with one catheter-related infection for a total of 93 catheters in situ. There were no infections reported for AVFs and AV grafts.
The introduction of the renal VAN position has resulted in a steady improvement in vascular access outcomes over the past decade for patients in this dialysis service.
Keywords: Vascular access, nurse, haemodialysis.

Introduction: Successful cannulation of arteriovenous fistula (AVF) or arteriovenous graft (AVG) is an important concept in hemodialysis. Metal needles have been used for cannulation in dialysis for over 50 years. Plastic cannula for dialysis is currently being introduced into Australia.
Aims: To identify if the implementation of plastic cannula could decrease the amount of miscannulations and adverse events in AVFs at first cannulation.
Methods: Train all staff in the Barwon Health renal department in the new technique of plastic cannula insertion and implement a new protocol for cannulation of AVFs in the first two weeks of dialysis.
Results: The training process took 12 months longer than anticipated due to issues with ‘expert’ to ‘novice’ reservations from staff, but initial results are positive with the statewide key performance indicator of new patients using AVF at first dialysis rising from 50% in 2013 to 78% in 2015. Staff were significantly more successful cannulating with plastic cannula in patients who had AVF only (67% success) than those who had a CVC alternative (24% success).
Conclusions: Plastic cannulas offer a new and innovative way to cannulate AVFs and with time, expertise and training can be utilized to provide a successful cannulation program for patients starting hemodialysis with AVFs.
Keywords: Cannulation, Dialysis, Plastic cannula, Renal, Vascular

Purpose: The purpose of this study is to examine the effect of the presence of tunnelled vascular catheter (TVC) on physician referral and surgeon review and operating patterns and ultimately time of creation of permanent haemodialysis (HD) access.
Methods: A retrospective analysis of TVC and arteriovenous fistulae (AVF) databases in 2010. Physician referral time and surgical time to operation were compared between patients commencing HD with TVC and a control group who commenced HD with AVF.
Results: The AVF group (n = 27) commenced HD with an AVF and TVC group (n = 49) commenced HD via a TVC. Time from physician referral to surgeon review in the AVF vs. TVC group was 29 vs. 35 days (p = 0.6). Time from surgeon review to access creation was 43 vs. 50 days (p = 0.4). However, in the TVC group, the time from TVC insertion to physician referral to a surgeon was an additional 109 ± 20 days. Subgroup analysis of 11 TVC patients (23%) presenting at end stage without AVF (crash starters) had a TVC to physician referral time of 103 ± 75 days, physician referral to surgeon review of 14.4 ± 4 days and surgeon review to AVF of 67 ± 23 days.
Conclusions: The presence of a TVC is associated with a significant delay (>3 months) before physicians make a referral for surgeon review. There was no surgeon-related delay to access creation related to the presence of a TVC.
Keywords: Arteriovenous fistula, Haemodialysis, Tunnelled vascular catheter