Pedro Ponce

By Bernard Canaud, Pedro Ponce, Maria Teresa Parisotto, Ellen Busink, Christian Apel, Jörg Rammo and Stefano Stuard

A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.

Part of the book: Vascular Access Surgery

By Pedro Ponce and Ana Mateus

Endovascular intervention in hemodialysis vascular access is among the most frequent interventions performed in an angiography suite. Vascular stenosis is the most prevalent lesion causing vascular access malfunction. Vascular access pathology and the outcomes in response to endovascular treatment are quite different from the arterial territory. Treatment strategy must be integrated, multidisciplinary, and with a long-term perspective, as recurrence rates of malfunction are quite common. We will detail our experience managing an extremely busy vascular access center serving a population of 4000 dialysis patients, performing all endovascular techniques in close coordination with the surgical team.

Part of the book: Cardiac Diseases

By Ana Mateus and Pedro Ponce

This chapter addresses three main topics (subchapters): (i) acquisition of educational skills in palliative care that are relevant to all health professionals and ways to implement these skills in the field of nephrology; (ii) ethical considerations that are applicable and support clinical and specific decisions at different stages of chronic kidney disease, such as, respect for bioethical principles in decision making related to dialysis withdrawal, effective communication with the patient and family, end of life care; and (iii) implementation and definition of key performance indicators that ensure quality of care and are patient-centred. These three (interrelated) pillars will strongly contribute to the (positive and expected) changes in the field of kidney palliative care.

Part of the book: Palliative Care - Current Practice and Future Perspectives [Working title]