Arteriovenous fistula, vascular access hemodialysis

Ilhan G, Esi E, Bozok S, Yurekli I, Ozpak B, Ozelci A, Destan B, Gurbuz A The clinical utility of vascular mapping with Doppler ultrasound prior to arteriovenous fistula construction for hemodialysis access. J Vase Access 2013 14 83-88. 

Catheters are placed when there is a clinical need for repeated sampling, injection, or vascular access, usually on a temporary basis. In kidney failure, catheters allow emergent blood access for hemodialysis and hemofiltration (Canaud, 2000), and provide temporary access as more permanent sites such as arteriovenous fistulas or grafts mature rerotola, 2000). Placement of a catheter or access port is routine for the administration of chemotherapeutic agents and intravenous nutritional supplements. Catheters are often placed when frequent, repeated doses of medication are to be injected. 

Special attention in such patients focuses on the presence and function of preexisting arteriovenous fistulae, hemodialysis central venous catheters, or access for peritoneal dialysis. Arms with vascular accesses are kept free from blood pressure cuffs, pulse oximeters, tourniquets and peripheral venous cannulae. 

Dialysis vascular access is currently the lifeline for hemodialysis patients. Unfortunately, due to the many complications associated with dialysis vascular access, it is also the Achilles heel of hemodialysis. A relatively ignored aspect of dialysis vascular access pertains to patient safety. The first part of this chapter will describe patient safety issues in the traditional context of arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs) and tunneled central venous catheter (tCVC). In the second half of this chapter, however, we will make the case that a nontraditional approach which emphasizes (a) individualization of care, and (b) patient preferences and patient involvement maybe our best opportunity to improve patient safety in hemodialysis patients. 

Saran R, Elder SJ, Goodkin DA, Akiba T, Ethier J, Rayner HC, Saito A, Young EW, Gillespie BW, Merion RM, Pisoni RL Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients results from the Dialysis Outcomes and Practice Patterns Study. Ann Surg 2008 247 885-891. 

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