Vascular access for hemodialysis: current perspectives

Abstract

A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%–60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA.

Catheter-related atrial thrombus: tip of the iceberg?

“…Many different complications may develop during replacement of a CVC such as arterial puncture, pseudoaneurysm, AVF formation, hematoma, air embolism, pneumothorax and malposition. 15 Furthermore, catheter infection and malfunction are commonly observed. On the other hand, right atrial thrombus is a less frequent complication but may lead to potentially serious consequences.…”

The care preferences of patients under hemodialysis

“…The need for hemodialysis, on the one hand, and the high-risk nature of this potentially harmful treatment, on the other, demonstrate the importance of the need for protection by nurses in these patients. Hemodialysis patients experience many symptoms and complications of CRF and their treatment and sometimes have to bear the nurses' multiple attempts to access their veins (25). Self-care was one of the abstract themes extracted in this study.…”

How to Perform Safe Anesthesia in Patients with End-Stage Renal Disease

“…internal pacemaker, defibrillator ICD, or cardiac resynchronization therapy) [14] . In these patients, the surgeon needs to brief the team ahead of time about the use of electrocautery.…”