A Short History of Vascular Access Care

Changes in Perception

Vascular access had been an area nephrologists historically didn’t get involved with, said Beathard, who is vice president of Provider Relations for Lifeline, an outpatient vascular access company. Everything vascular-access related was relegated to consultant, primarily surgeons. In addition, training lagged in dialysis-specific vascular access training. “The problems were largely being ignored,” Beathard added. “In some sense, we were just beginning to be aware of the problems. People were beginning to look at vascular access in other parts of the world, and realized the United States was in worse shape than any other place in the world. Europe, Asia, even Third-World countries.”

“If you go back 10 years or so ago, that was the approximate time nephrologists really got concerned and involved in making dialysis access better,” Beathard said. In 1997, the National Kidney Foundation released the Dialysis Quality Outcomes Initiative (K/DOQI), which included a goal of placing a fistula in 50 percent of all new dialysis patients. “Things started improving before DOQI came along, but I think DOQI guidelines gave a major impetus to change and improve, but it was happening very slowly.”

Fistula First was the next step that gave people a more forceful nudge and really caused things to accelerate, according to Beathard. “Fistula First reached out and got people involved directly, he added.”If one were focus on any group in the whole system that’s had a major impact, though, it would be the dialysis nurses. Nurses tend to be patients advocates to begin with. That’s just their nature, their training and that’s where their heart lies.”

Interventional Nephrology

Interventional nephrology was another driver that had an impact vascular access care because it offered nephrologists an opportunity to get directly involved, said Beathard. “The thing that was driving it was the view on the part of the practicing nephrologist that his patients need and deserve better, and he wasn’t able to get it in many instances, so he decided, perhaps, the best option would be to provide it himself.”