Renal vascular access

 

Our renal vascular access team support, inform and arrange for patients to have the right type of access for their kidney treatment.

Vascular access is any form of adaptation that helps you receive your treatments, via a surgically created vein used to reach your blood, so that it can be filtered and cleaned during haemodialysis.

Your vascular access will be made by one of the surgeons during a minor procedure. Once your access has been set up, you can start haemodialysis treatment.

We need to make sure your vascular access is functioning well. Our specialist nurses will teach you about good access care and what to do if there are any problems.

More on what we do

Your vascular access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer.

An access can be one of the following:

  • A fistula, an access made by joining an artery and vein in your arm.
  • A graft, an access made by using a piece of soft tube to join an artery and vein in your arm.
  • A catheter, a soft tube that is placed in a large vein, usually in your neck.

Whether your access is a fistula, graft or catheter, it's vital that you take good care of it. Vascular access is one of the most important aspects of kidney care.

The dialysis access nurse specialists will help you to look after your renal vascular access and help if there are any problems.

Our specialist nurses also:

  • Help to prioritise patients and arranges referrals to nephrologists, vascular surgeons, imaging and/or interventional radiologists.
  • Co-ordinate the booking and admission of patients for renal access surgery.
  • Assist the Dialysis Access Surgeons at the Dialysis Access Clinics, providing relevant patient information. We can help refer for surgery, where appropriate.
  • Manage a nurse-led outpatient service for renal vascular access.
  • Act as a specialist resource for the care and management of Central Venous Catheter Devices within Renal Services, including the removal and placement of Central Venous Catheters.
  • Monitor patients for complications to prolong the life of the access.
  • Co-ordinate the delivery of care to patients with problems and emergencies because of failed or poor dialysis access. Monitoring is carried out in the individual haemodialysis unit. If problems are detected, the patient is referred back to the RD&E's Kidney Unit for specialist assessment.
  • Work with the Infection Control Department, monitoring and auditing infection rates and implementing changes to practice.
  • Contribute to the Trust clinical governance agenda through education, clinical guidance, production, audit and research.

Treatments

Ultrasound

Our specialist nurses can help monitor dialysis access using ultrasound. Ultrasound and Colour Doppler is a non-invasive test that can be used to estimate the blood flow through your blood vessels. The technique bounces high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can't show blood flow. Ultrasound and Colour Doppler is a powerful tool, used for early diagnosis of problems of vascular access complications in haemodialysis patients.

Transonic Access Flows

Transonic flows are carried out on haemodialysis. Transonic flow measurements inform the dialysis access nurses, surgeons, the nephrologist (kidney doctor) and the interventional radiologist how well your vascular access is working. A well-functioning vascular access is critical for end-stage renal disease (ESRD) patients, whose kidney function is replaced by haemodialysis.

Our team

Senior clinical nurse specialist - dialysis access - Louise Oakaby

The nurse lead for renal dialysis access and renal day case service. Non-Medical Prescriber. IRMER trained (Ionising Radiation (Medical Exposure) Regulations), requesting procedures and interventions in Interventional Radiology. Provides specialist Dialysis Access care within the hospital and associated satellite units to all renal patients, including those with complex needs. 

Clinical nurse specialist – dialysis access- Helen Maxted

Provides specialist Dialysis Access care within the hospital and associated satellite units to all renal patients, including those with complex needs, using clinical knowledge that is evidence based.

Clinical nurse specialist – dialysis access - Joe Mulligan

Provides specialist Dialysis Access care within the hospital and associated satellite units to all renal patients, including those with complex needs, using clinical knowledge that is evidence based.

Consultant nephrologists

Our consultant nephrologists are doctors that specialise in treating diseases of the kidney. Not only do they have expertise on diseases that specifically affect the kidney, but they’re also very knowledgeable about how kidney disease or dysfunction can affect other parts of your body.

  • Dr CL Smyth,
  • Dr R D’Souza
  • Dr C Bingham
  • Dr HC Clarke
  • Dr M Bello-Villalba
  • Dr C Mulgrew
  • Dr J Moore,
  • Dr DJ Meredith
  • Dr RA Oram
  • Dr RL Clissold
  • Dr BA Flower
  • Dr MA Gilchrist
  • Dr MB Stojakowska 

Vascular/renal access surgeons and interventional radiologists

Consultant vascular and renal access surgeons:

  • Mr AR Cowan
  • Mr DW Birchley
  • Miss AJ Guy
  • MR AB Wilmink 

Consultant interventional radiologists: 

  • Prof AF Watkinson
  • Dr AJ Gemmell
  • Dr RM Guiness
  • Dr RH Llewellyn

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

Room S55, Sid Ward Template, next to the Haemodialyis Unit.

Contact us

Telephone

To contact us call 01392 402174 / 6361 or Renal Day Case Unit on 01392 404791 / 4792.

Email

louise.oakaby@nhs.net

helen.maxted@nhs.net

joseph.mulligan@nhs.net

Clinics

Dialysis Access Clinics

The dialysis access clinics are held in the Clinic Room, Sid ward on the Kidney Unit. There are usually three clinics a week with the surgeons and clinical nurse specialist for dialysis access. 

Patients are asked to attend the dialysis access clinic for assessment if they need to have a arteriovenous (AV) fistula. If an AV fistula is required, the patient will be seen by a surgeon in the dialysis access clinic. The surgeon will ask some questions and look at your arms to assess the veins for creating an AV fistula. The patient will have a scan of their arms to work out how deep the veins are and what size/calibre (quality) they are. After the scan, the surgeon will plan the vascular access.

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