Trusts with autonomous renal centres should
ensure adequate surgical expertise and theatre time is
dedicated to vascular and peritoneal access. One weekly
theatre session per 120 patients (approximately) on dialysis
is needed.
Service level agreements between the renal
service and departments of general or vascular surgery
and radiology should stipulate case mix and numbers of
operations/interventions required per annum. Arrangements
involving transplant surgeons may be possible in some
centres.
Seniority and expertise of surgeons/radiologists
involved should be audited together with survival rates
of natural fistulae, tunnelled catheters and CAPD catheters.
Access operations should be timely to ensure
the majority of planned (non emergency) patients have
functioning, 'permanent' access when dialysis commences.
Overall the service should aim to have the percentage
of new HD patients with natural arteriovenous fistulae
(AVF's) approach the European average of 66%.
Efforts to reverse the decline in the proportion
of HD patients using AVF's should aim to return to the
European average for prevalent patients (80%) which will
involve cooperation with surgical departments, Trusts
and commissioning agencies.
These initiatives will require an elevation
of the profile of access surgery in manpower planning
and continuing discussions between the Specialist Workforce
Advisory Group (SWAG) and Postgraduate Deans.
