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This article reviews vascular access (VA) assessment methods and procedures. It gives an overview of the existing methods for bed-side VA assessment by means of pressures, recirculation and access flow measurement. Pros and cons of the methods are discussed and additional benefits of a combined recirculation and access flow measurement are explained. Present vascular access care guidelines are discussed, namely the K/DOQI and EVAS documents. Practical setup of a vascular access monitoring and surveillance system is illustrated with data from the authors' own unit where such a system has been in use since 1999. The issue of adequate target setting is analysed in view of published works on clinical impact of access surveillance system introduction (timely detection of access stenosis and access patency). Critical re-evaluation is needed especially in current QVA threshold and intervention timing.

The significance of nosocomial infections is increasing. The reasons for this are a higher concentration of problematic patients in hospitals due to the increasing number of outpatient surgeries, the increase of invasive therapeutic and diagnostic procedures, the growing share of immunodeficient patients as well as the increase in antibiotic-resistant and multiresistant pathogenic organisms. Basic changes in the medical system call for a systematic discussion about directed quality management. Surveillance, i.e., the systematic registration and evaluation of occurred diseases as well as the feedback to the personnel in charge is very important in this context, particularly when complemented by comprehensive hygienic measures. The growing significance of hospital infections increasingly triggered by multiresistant pathogenic organisms emphasizes the importance of general prevention. Each hospital has to determine which surveillance methods for the registration of nosocomial infections and multiresistant pathogenic organisms are the most appropriate under their respective conditions. To get a first idea of possible problem areas, prevalence studies are very suitable for the start before moving on to well-directed incidence studies in certain wards and for certain kinds of infection.