Welcome to Dialysis Patient Care!

Sunday, October 31, 2010

Vascular Access: Makes Chronic Dialysis Possible

Image Source: barwonvascular.com.au

After completing this module, the learner will be able to:
• Describe the three main types of vascular access.
• Identify the predialysis assessments for all types of vascular access.
• Describe the methods of needle insertion forAVFs and grafts.
• Describe the predialysis assessment, accessing procedure, exit site care, and monitoring of catheters.
• Vascular access makes chronic hemodialysis possible because it allows the care team to "access" the
patient's blood.
• And access can be internal (inside the body) or external (outside the body).

It must:
• Allow repeat access to the blood
• Handle blood flow rates that will ensure effective treatments
• Be made of materials that are not prone to causing reactions or infections

The three main types of access are:
• Fistula
• Graft.
• Catheters
• To create a fistula, a surgeon sews an artery and a vein together, most often in the arm.
• Arteries carry oxygen-rich blood from the heart and lungs to the rest of the body.
• The vessels selected for a fistula are large and have good flow, but are deep below the skin and hard to reach with needles.
• Veins bring blood back to the heart and lungs; they are easy to reach, but too small and too slow flowing for dialysis.
• Linking an artery and a vein is the best of both worlds.
• In 4-6 weeks, high-pressure blood flow from the artery thickens the vein wall and makes it dilate (enlarge) so large needles can be used.
• Because a fistula is below the skin and is the patient's own tissues, it is less prone to infection and clotting
than other types of access.
• A fistula can last for years - even decades - and research shows it is the best type of access now available.
• To create a graft, a surgeon links an artery and vein with a piece of artificial blood vessel.
• Like a fistula, a graft allows access to the large volume of blood needed for dialysis.
• Grafts are more prone to stenosis (narrowing of blood vessels), which can cause thrombosis (blood clots).

• Grafts are also more prone to infection than fistulas, and have a shorter useful lifespan (less than 5 years on average)

• Grafts are an option for patients who do not have blood vessels suited to create a fistula.
•  A catheter is a plastic, hollow tube placed in a deep central vein in the chest or leg.
• They allow short-term or long-term access to patient's blood.
• Deep central veins have a blood flow rate that allows adequate treatments.
• Catheters are made up of plastic that is foreign to the body, and they pass through the skin, creating a portal for bacteria.
• They are prone to stenosis, blood clots, and infection.
• Due to these problems, catheters must be replaced in the same or new vessels.
• Catheters are used for patients who:
     • Can't have a fistula or graft
     • Are waiting for a fistula or graft to be placed or to mature
     • Have acute kidney failure and may soon recover kidney function
     • Are waiting for a peritoneal dialysis catheter
     • Are waiting for a live donor kidney transplant
• Access is still the one greatest challenge to the success of dialysis.
• Access problem frustrate the care team and the patient.
• Trouble cannulating (putting needles into) fistula and grafts is a source of stress for both.
• Poor cannulation can lead to problems that may cause access failure.
• Access failure means loss of the dialysis lifeline.
• The NKF KDOQI and the Fistula First program are two ongoing efforts to improve access outcomes

Vascular Access: Makes Chronic Dialysis Possible - Related Hemodialysis Article


Post a Comment

Latest Article


hemodialysis,peritoneal dialysis, dialysis machine, kidney dialysis, dialyse, dialyzer, dialyse tubings, complications of dialysis, dialyzer reprocessing, protein dialysis, kidney transplant, hemodialysis diet, renal nurse, renal failure, hollow fiber membranes, minerals and electrolytes, kidney treatment, dialysis treatment