Szymon Brzósko

We were talking today about improving our EHR documentation around BP measurement and I forgot these best practices had been discussed in the 2017 NHLBI Workshop on BP assessment. Anyone practice this?

📚 Based on:
"Hemodialysis Vascular Access: A Historical Perspective on Access Promotion, Barriers, and Lessons for the Future"
Kidney Medicine, 2024
t.co/UKjAyORInb
16/16

🔑 Take-Home Message:
"The best time to plan vascular access was months ago. The second best time is now."
Share this thread with your colleagues!
#VascularAccess #KidneyHealth #MedEd
15/16

🎯 Goals for Success:
• Catheter-free initiation
• Long-term access survival
• Reduced complications
• Better patient outcomes
14/16

💪 Patient Education Must Include:
• Access care
• Arm exercises
• Warning signs
• Emergency contacts
Empower your patients!
13/16

📱 Monitoring Schedule:
• Weekly checks during maturation
• Physical examination
• Ultrasound when needed
• Flow measurements
Stay vigilant!
12/16

👥 Team Approach Required:
• Nephrologist
• Vascular surgeon
• Access coordinator
• Dialysis staff
• Primary care physician
Success needs collaboration!
11/16

⚠️ Common Mistakes:
• Waiting too long
• Skipping vascular mapping
• Ignoring early signs of failure
• Poor monitoring during maturation
10/16

🔄 Progression of Care:
Week 1: Initial evaluation
Week 2-3: Vascular mapping
Week 4: Surgical consult
Week 6-8: Access placement
Months 4-6: Maturation
9/16

💡 Smart Planning:
1. Early nephrology referral
2. Vascular mapping
3. Patient education
4. Regular monitoring
5. Timely surgical consultation
8/16

🚩 Red Flags for Early Referral:
• Rapid eGFR decline
• Resistant hypertension
• Uncontrolled diabetes
• Advanced age with CKD
Don't wait for crisis!
7/16

📈 Success Rates with Proper Timing:
• 88% catheter-free starts with well-timed AVF
• 48% with AVG
• Timing is everything!
6/16

🎯 Pro Tip: The "Crash-Landing" Problem
• Almost 50% of US patients start dialysis unprepared
• No permanent access in place
• Results in avoidable catheter use
We can do better!
5/16

⏰ Maturation Times:
• AVF: 4-6 months
• Standard AVG: 10-14 days
• Early cannulation AVG: 24-72 hours
Know these timelines for better planning!
4/16

📊 Timing Guidelines for AV Access:
• Evaluate when eGFR approaches 15-20 mL/min
• Plan AVF 4-6 months before expected dialysis
• Consider AVG 2-3 weeks before need
3/16

🔑 Key Question: When should we plan and place vascular access for hemodialysis?
Short answer: Predialysis placement of adequate access directed by an orderly planned process, which provides sufficient lead time for maturation.
2/16

🧵 Let's talk about Hemodialysis Vascular Access Timing: A Critical Guide for Healthcare Providers
#Nephrology #Hemodialysis #MedTwitter
1/16

Ha! Thank you. Primary results seemed to be promising … have seen the paper, after a few uses no OR time usage prol. and less incidents

Instructive & interesting, thx!

Have a Q from outside nephrology .. #PtSafety am discussing tommorow retained surgical sponges and preventing measures with operating rooms staff I found this interesting system! In PL it is not used, but is it in use in any other countries? @stevenshorrock.bsky.social @patientsafetylearning.org

Yes, actually neither me strong in pathology ;) - but diseases related to other options not very much clinically associated with myopathy what is the case for glycogen storage disease type V :)

Let me do the same :) with a picture of my daughter I took few years ago #kids

Neph pearls never fading 👇🏻👍

No risk of hearing “specimen not representative” from your nephropathologist 👇

On January 1, 2024, new regulations came into force in Poland, prohibiting the sale of energy drinks to people under 18 years. The regulations also prohibit the sale of such drinks at schools and other educational units, as well as in vending machines www.wsz.pl/wp-content/u...

Witaj przyjacielu!!!

....been on Eliquis (Apixaban) almost a year now, it's INCREDIBLE! No heparin needed.... I combine with baby asprin.. so potent that most patients of 150lbs or less just need 2.5mg....sometimes need to skip on non dialysis days if I notice needle sites slightly bleeding after 8hrs...

🌟 Hello, BlueSky community! 🌟
I'm Szymon Brzósko, a nephrologist passionate about advancing kidney health and improving patient care. Excited to connect, share insights, and collaborate on innovative solutions in nephrology here :) Hope to connect with nephro friends.