VASCULAR ACCESS FOR HEMODIALYSIS

Vascular access is a critical component of hemodialysis, providing a way to remove and return blood to the body during the dialysis process. The type of access chosen affects the success and safety of the treatment.

Types of Vascular Access

1. Arteriovenous (AV) Fistula
   • Description: A surgical connection between an artery and a vein, usually in the forearm or upper arm.
   • Advantages:
     • Long lifespan.
     • Lower risk of infection and clotting.
     • Best for long-term dialysis.
   • Disadvantages:
     • Requires 6–12 weeks or more to mature before use.
2. Arteriovenous (AV) Graft
   • Description: A synthetic tube connects an artery to a vein, used when veins are unsuitable for a fistula.
   • Advantages:
     • Shorter maturation time (2–3 weeks).
     • Suitable for patients with small or weak veins.
   • Disadvantages:
     • Higher risk of infection and clotting than a fistula.
3. Central Venous Catheter (CVC)
   • Description: A flexible tube inserted into a large vein in the neck, chest, or groin.
   • Advantages:
     • Can be used immediately.
     • Useful for temporary or emergency dialysis.
   • Disadvantages:
     • High risk of infection and clotting.
     • Not ideal for long-term use.

Choosing the Right Access

The selection of vascular access depends on several factors:

• Health of the Patient’s Veins: Determines suitability for fistula or graft.
• Duration of Dialysis: AV fistula is preferred for long-term use.
• Urgency of Dialysis: CVC is used for immediate access.
• Patient’s Overall Health: Comorbidities like diabetes or vascular diseases may influence the decision.

Care and Maintenance of Vascular Access

1. Hygiene:
   • Keep the access site clean and dry.
   • Avoid wearing tight clothing or jewelry over the access site.
2. Monitor for Complications:
   • Look for redness, swelling, or pain (signs of infection).
   • Check for a “thrill” (vibration) in the fistula or graft daily.
   • Report bleeding, clotting, or changes in blood flow immediately.
3. Protect the Access:
   • Avoid blood pressure measurements or needle sticks on the access arm.
   • Do not carry heavy objects or sleep on the access arm.
4. Routine Check-ups:
   • Regularly assess the functionality and health of the access.

Potential Complications

• Infections: More common with CVCs and grafts.
• Clotting: Can occur in any type of access, reducing effectiveness.
• Steal Syndrome: Reduced blood flow to the hand, causing pain or numbness (more common in AV fistulas).