Integrated vascular access management.

Nephrologists need to deal with the problem of vascular access management in the same manner as the other major problems that affect our dialysis patients. We need to become experts in vascular access and we need to occupy a pivotal position in directing the decisions that are made that affect dialysis patient welfare. An integrated vascular access management strategy is required. Optimally, there should be four components to this strategy - evidence-based policies and procedures, a dedicated vascular access facility, committed vascular access surgeons and the availability of committed vascular access interventionalists. In many respects this is the approach that offers the best in quality of patient care and is also the most economic to deliver.