Internal department of Strahov

The basic focus of the Center for Vascular Approaches (CCP) VFN, of which we are a part, is a comprehensive care of vascular approaches for extracorporeal cleansing methods. These include the establishment of vascular access, comprehensive diagnosis and treatment of complications of vascular access, which are the most common cause of morbidity in dialysis patients. In addition to this clinical work, the Center provides for the improvement of diagnostic and logistical issues in the field of scientific research and provides education for other specialists.

At our workplace, we provide vascular access for hemodialysis to patients with chronic renal failure. We implant acute (temporary) and permanent (long-term) catheters, we solve complications associated with catheters: infections, mechanical complications, functional disorders. We perform outpatient services even during short-term hospitalizations. We provide our services to patients not only from our dialysis center, but also from hemodialysis centers throughout the Czech Republic. Our workplace is part of the Center for Vascular Approaches for Extracorporeal Purification Methods.

In solving complications we cooperate with II. the Department of Cardiovascular Surgery of the General Hospital and the Radiodiagnostic Clinic of the General Hospital. Similar to subcutaneous vascular access, all permanent central venous catheters introduced in our department are monitored as part of the development of a separate monitoring program. The members of the catheterization team are members of the Czech Society for Vascular Access and pass on their experience at professional events. The educational video can be viewed on YouTube under the title Central tunneled venous catheter for hemodialysis.

The center was established on 18.1. 2010 by the decision of the director of VFN on the proposal of the workplace with the following goals of its activity:

• elaboration of clinical trials and conducting of clinical trials within the procedure of granting the CE mark to medical devices in the field of dialysis, assessment of clinical trials performed for notified bodies by other entities,
• consultations, tests, measurements and cooperation with research and development departments of dialysis technology manufacturers.

Participation in multicentre international projects also fits into these activities. A number of smaller projects are solved in the form of final bachelor's and master's theses. Part of the dissemination of the results of these works is the corresponding publishing activity.

The actual establishment of the Center was preceded by medical-technical and technical activities developed at the Strahov dialysis center practically from its inception thanks to the emphasis placed by its founder prof. MUDr. Albert Valek, DrSc. († 1998) on the multidisciplinarity of the work team. A clinical engineer, qualified doctors - nephrologists and a team of experienced dialysis nurses are available at the Center for the mentioned works. Since its establishment, the Center has prepared a number of clinical trials of medical devices in the field of dialysis for Czech and foreign manufacturers and has also carried out a number of clinical studies, either alone or as part of multicenter projects. The latest activity of the workplace is the testing (and already implementation in practice - the first in the Czech Republic!) Of home frequency hemodialysis with low dialysate flow (American System One by NxStage).

The center is able to provide comprehensive care for patients with chronic renal failure, from the pre-dialysis clinic through outpatient operation of the dialysis center to the resolution of complications and eventual hospitalization in the inpatient department.

The department also provides counseling examinations of patients from other hemodialysis centers, both on an outpatient basis and during hospitalization. We provide these counseling services mainly to patients with complicated vascular access for HD (in cooperation with the 2nd Department of Surgery of Cardiovascular Surgery of the 1st Medical Faculty of Charles University and the General Hospital and the Radiodiagnostic Clinic of the 1st Medical Faculty of Charles University and the General Hospital) and patients with advanced or complicated renal osteopathy.

Four programs already have a stable formalized structure

• Renal replacement program
• Program for the diagnosis and treatment of mineral bone disorders in chronic kidney disease
• Program of securing and monitoring of vascular access for hemodialysis
• Wound healing program in dialysis patients

At the Internal Department of Strahov VFN, peritoneal dialysis (PD) treatment has been performed continuously since 1978. Peritoneal dialysis is performed in its entirety: education and choice of method in predialysis, catheter implantation in cooperation with surgical departments and subsequent postoperative care, education of patients and families. members, treatment with automated PD, monitoring the adequacy of dialysis, transport characteristics of the peritoneum, quality of life, nutritional status, treatment of acute and chronic complications, the possibility of assisted PD, etc. The great advantage of the workplace is a multidisciplinary team caring for patients including clinical psychologists, nutritionists and rehabilitation workers. Since 2010, we have been a specialist VFN center for peritoneal dialysis treatment. We lead extensive cooperation and the provision of superconciliary assistance to other dialysis centers in the Czech Republic. Since 2014, when a network of workplaces offering assistance in performing peritoneal dialysis was created within the CNS, our workplace one of them.

An important part of the PD program is the education of doctors and nurses from other workplaces. In cooperation with the Department of Education of the General Hospital, courses have been held at our workplace several times a year since 2010, intended for nurses concerning the implementation of assisted peritoneal dialysis. This is a course accredited by the Ministry of Health of the Czech Republic. The professional guarantor of the course is Mrs. Ludmila Nermutová and MUDr. Barbora Szonowská.