In Dialysis Treatment, Vascular access is one of the vital procedures.
Overview on vascular access:
Before beginning hemodialysis treatment, a person needs an access to their bloodstream, called a vascular access. The access allows the patient’s blood to travel to and from the dialysis machine at a large volume and high speed so that toxins, waste and extra fluid can be removed from the body.
In reality, creating an access to a patient involves multiple procedures (like access cannulation, fistulagram, infiltration etc) performed during different time periods, therefore we cannot map an Access to a single Procedure FHIR resource. Typically more than one Procedures performed can be related to single Vascular Access.
In our existing non-fhir model, we have maintained VascularAccess as a separate domain entity (or Resource) which essentially contains but is not limited to,
- Access type - AV Fistula (Arteriovenous Fistula) / AV Graft / Catheter
- Access sub type - Bovine / Standard / Double Cuff / Tunneled
- Body site (whereWasAccessPlaced) - Above Elbow / below Elbow / Right Lower Quadrant
- Access status – Active / Maturing / Removed / Permanently unusable
We are trying to find an appropriate FHIR resource for mapping Access,
Here is our open question?
- Can we consider a Vascular Access as a Device or DeviceComponent?
below are the various access types,
AV Fistula - its a method of connection between an artery and a vein which doesn’t involve any DeviceComponent but blood vessels.
AV Graft - A graft is tube (Device) that is inserted to connect an artery to a vein.
Cathether - it could be a Device component.
We would ideally need a Resource which would map the access type with a BodySite(location) and with an operational status.