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Message from the chair of CEN.

Collaboration and sharing

This document represents the culmination of a project that was undertaken approximately two years ago by the Greater Toronto Area Nephrology Clinical Educators Network (CEN). Motivated by common challenges in nursing practices across the region related to vascular access in hemodialysis patients, the group identified the need for the collaboration and sharing of experiences and expertise, specifically in the areas of new vascular access management and central venous catheter management. These are offered as clinical practice guidelines rather than standards of practice, and are based on evidence where it exists. Some topics offered little or no published literature and in those instances, comments are based on the expert opinion of the members of the group. Our hope is that these guidelines will assist Canadian nurses in preparing unit policies and protocols, as well as education and documentation tools. Further, it is hoped that they will encourage nursing research studies that will add to the body of existing literature--in the interest of improving patient outcomes on hemodialysis.


The members of the nephrology Clinical Educators Network (CEN) have collaborated to establish recommendations with respect to the development of and management of a new vascular access and central venous catheter for a patient on, or starting hemodialysis. This document is based on a combination of evidence found in the literature and clinical expertise. These recommendations are intended for use as a guideline, which may be personalized to meet the individual needs of any hemodialysis program, unit or patient.

Clinical practice guidelines

The CEN membership believes that wherever possible, recommendations related to the management of a new vascular access or central venous catheter must be based on existing clinical practice guidelines for vascular access such as the Canadian Society of Nephrology Clinical Practice Guidelines for Vascular Access (1999), and/or the Kidney Disease Outcome Quality Initiative (K-DOQI) Guidelines for vascular access (Update 2001).

Evidence-based practice

The CEN membership believes in the importance of providing patient care in an evidence-based environment. Therefore, wherever possible, these recommendations are based on existing evidence that has been published in the literature.

Experiential knowledge

The CEN recognizes that in some areas of practice, due to lack of evidence, experiential knowledge will be the only reference available for development of the recommendations. The pooling of expertise among expert nurses maximizes clinical knowledge and can support recommendation development (Benner, Tanner, & Chesla, 1997). In this case, the recommendations will be made in light of the fact that there is no formal evidence upon which to base the opinion of the group, and will be identified as (opinion).

About the CEN

The CEN is a branch of the Renal Educators Network, which comprises clinical educators working in various areas of nephrology in Ontario and Eastern Canada.


These guidelines are endorsed by the Canadian Association of Nephrology Nurses and Technologists (CANNT).

French translation

French translation by Luce Tessier, CTr, OTTIAQ, BA(Tr).


Benner, P., Tanner, C.A., & Chesla, C.A. (1997). The social fabric of nursing knowledge. American Journal of Nursing, 97(7), 16BBB-16DDD.

Jindal, K., Ethier, J., Lindsay, R., Barre, P., Kappel, J., Carlisle, E., & Common, A. (1999). Clinical practice guidelines for vascular access. In Clinical practice guidelines of the Canadian Society of Nephrology for treatment of patients with chronic renal failure. Journal of the American Society of Nephrology, 10(Suppl. 13), S287-S321.

National Kidney Foundation. (2001). NKF-K/DOQI Clinical practice guidelines for vascular access: Update 2001. Retrieved from

Alison Thomas, RN, MN/ACNP, CNeph(C)

Chair, Nephrology Clinical Educators Network (CEN) working group for the development of vascular access guidelines for hemodialysis

Correspondence to Alison Thomas, Clinical Nurse Specialist/Nurse Practitioner Hemodialysis, St. Michael's Hospital, Toronto, Ontario, Canada. E-mail:

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Article Details
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Author:Thomas, Alison
Publication:CANNT Journal
Geographic Code:1CANA
Date:Jul 1, 2006
Previous Article:Ode to old nurses.
Next Article:Chapter one: recommendations for new vascular access management in hemodialysis patients.

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