|Title||Haemodialysis Access and Reconstructive Surgery Assessment|
By the end of this module, the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to undertake haemodialysis access assessment including pre fistula formation upper and lower limb arterial and venous assessment, arterio-venous fistula (AVF) assessment, access (AV) graft assessment and other pre-reconstructive surgery assessment which requires knowledge of arterial and venous anatomy and function. They will also be able to recognise, deliver, report and interpret the appropriate physiological test/s to address the findings from initial clinical assessment and apply a detailed knowledge of management options available to the supervising clinician based on the investigative findings whilst critically evaluating their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Vascular Scientist.
Knowledge and understanding
By the end of this module, the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the assessment of a range of patients, including those with complex problems with respect to pre and post arterio-venous fistula assessment including:
Anatomy, Physiology and Pathophysiology
- typical anatomy and common variants.
- requirements of the arterial and venous system suitable for AVF / graft formation
- e.g. diameter, patency, level of brachial artery bifurcation, arterial waveform shapes.
- the anatomy of a whole range of permanent haemodialysis access e.g. AVF radial- cephalic, brachio-cephalic, lower limb AV access grafts.
- range and variety of pathology including:
- AVF stenosis.
- aneurysm and pseudo aneurysms.
- reduced inflow e.g. due to stenosis or occlusion.
- reduced outflow e.g. due to stenosis or occlusion.
- steal e.g. via the hand.
- haemodialysis access haemodynamics including detailed understanding of good and pathophysiological blood flow.
- normal anatomy of vessels that may be involved in reconstructive surgery
- range of reconstructive surgery performed
Diagnostic procedures and therapeutic interventions
- techniques used to perform haemodialysis.
- alternative techniques used within the dialysis unit to assess fistula / graft function.
- ultrasound techniques used to measure blood volume flow and the potential sources of error.
- volume flow measurement criteria for recommending further investigation.
- potential consequences of the presence of very high volume flow.
- criteria for assessing stenosis.
- protocol for accessing haemodyalisis access e.g. blood flow measurement in supplying artery, vein diameter and depth, abnormalities.
- methods of reporting e.g. use of diagrams.
- the diagnostic techniques used by clinical vascular scientists to assess haemodialysis access grafts and pathology that may be encountered
- selection of the appropriate technique for each patient.
- complementary use of fistulogram, CT and MRA in the diagnosis and management.
- pre-operative assessment of vessels that may be used within reconstructive surgical techniques e.g. peripheral arteries and veins, epigastic arteries and perforating vessels
- assessment of blood flow post reconstructive surgeryManagement Options
- presenting signs and symptoms and identify possible alternative diagnoses.
- range of medical, interventional and surgical management options.
- recognition of the clinical sequelae of the diagnosis.
- recognition of how diagnosis affects management pathway.
- role of haemodialysis access surveillance.
Technical and clinical skills
By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:
- Pre-fistula or graft formation duplex and spectral Doppler assessment of the upper and lower limb arterial and venous systems.
- Arterio-venous fistulae AVF conduit assessment including measurement of flow volume.
- AV graft assessment including Polytetrafluoroethylene (PTFE) loop upper and lower limb.
- Assessment of other complex AVF formations.
- Identification of artefacts and potential sources of error and take appropriate action.
By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:
- develop the service to improve outcomes for patients, for example, improving fistula patency and predicting and preventing problems.
- develop and maintain departmental protocols for assessing haemodialysis access and pre- AVF / graft formation.
- take a clinical history and perform clinical assessment of patient.
- choose and provide expert opinion on the most appropriate technique/test for the clinical presentation.
- perform the ultrasound imaging or physiological measurement diagnostic test
- analyse and interpret physiological images and measurements.
- formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report cases and emphasise the key findings and diagnoses.
- compare all data to justify and validate the conclusion.
- communicate with the multi-disciplinary team and participate in multi-disciplinary teams.
- lead, develop, manage, evaluate and improve surveillance programmes.
- reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Attitudes and behaviours
By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- prioritise the safety of the patient.
- consistently work to high standards of clinical practice applying knowledge and evidence, making decisions and evaluating the impact of those decisions.
- monitor, evaluate and maintain clinical practice standards.
- share data on clinical practice standards with service users and managers to encourage dialogue and debate.
- recognise the importance of the multidisciplinary clinical team and takes responsibility for ensuring appropriate and effective decision making processes are in place.
- support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.communicate appropriately with the patient and place the patient at the centre of care.
- be committed to and support continuous improvement of vascular services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.