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Hemodialysis requires frequent access to the patient's blood stream
(vascular system). Vascular access has been called the "Achilles'
Heel" of hemodialysis care. Hemodialysis vascular access procedures
and associated costs come to $8,000-10,000 per patient per year.
This amount represents approximately 25 percent of total ESRD medical
costs. The most common problems are stenosis (narrowing of graft/blood
vessel), infection, and thrombosis (clotting).
At present, three types of vascular access are predominant: AV
(arteriovenous) fistulas, AV grafts, and catheters. AV fistulas
are surgically created by connecting a patient's own artery and
vein, usually in the forearm. AV fistulas have the lowest rate of
complications, but take from several weeks to several months to
mature, heal, and develop in size. Over time, an AV fistula becomes
large enough to accommodate the needles required for hemodialysis.
AV grafts are also created surgically, but use a synthetic blood
vessel to connect the vein and artery. The needles are inserted
into this synthetic graft. AV grafts require shorter times (if any)
to heal before they can be used, but tend to have more incidents
of stenosis and thrombosis than AV fistulas. Catheters are most
often used as "bridge" devices, used to bridge the time
between from start of dialysis treatments (often an emergency) to
when the patient's AV fistula or AV graft has matured and is ready
for use. Catheters are generally not used as long-term devices as
they tend to have higher rates of infection and thrombosis.
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Endovascular
Treatment of Hemodialysis Arteriovenous Fistulas: Is Immediate Post-Interventional
Blood Flow a Predictor of Patency - Article in Press abstract from
the Journal of Vascular Access. - January 18, 2012
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Articles
in Press Abstracts from the Journal of Vascular Access - January 17, 2012
• More
Precise Diagnosis of Access Stenosis: Ultrasonography Versus Angiography
• Long-Term
Arterial Adaptation to High Blood Flow in the Feeding Artery of Vascular
Access for Hemodialysis
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Pharmacotherapy
to Improve Outcomes in Vascular Access Surgery: a Review of Current Treatment
Strategies - Advance Access Abstract from NDT - January 13, 2012
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Management
of Dialysis Access Associated "Steal" Syndrome with DRIL Procedure:
Challenges and Clinical Outcomes - Article in Press abstract from
the Journal of Vascular Access. - January 13, 2012
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Safety
and Efficacy of Local Periadventitial Delivery of Sirolimus for Improving
Hemodialysis Graft Patency: First Human Experience with a Sirolimus Eluting
Collagen Membrane (Coll-R) - Advance Access Abstract from NDT - January
11, 2012
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Articles
in Press Abstracts from the Journal of Vascular Access - January 10, 2012
• Evaluation
of Central Vein Sizes in Patients with Autogenous Hemodialysis Fistulas
• Early
Use of Brachial Basilic Arteriovenous Fistula
• Assessment
of Long-Term Vasoplegia Induced by Brachial Plexus Block: a Favorable
Effect for Hemodialysis Angioaccess Surgery?
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Systematic
Evaluation of Vascular Access by Color-Doppler Ultrasound Decreased the
Incidence of Emergent Vascular Access Intervention Therapy and X-Ray Exposure
Time: A Single-Center Observational Study - Early View Abstract from
Therapeutic Apheresis and Dialysis - January 5, 2012
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Vascular
Access Community Benefits in Final Medicare Fee Schedule Rule for 2012
- January 4, 2012
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Effect
of Mechanical Brushing on Survival and Hemodynamic Characteristics of
Tunneled Hemodialysis Catheters - Article in Press abstract from the
Journal of Vascular Access. - January 4, 2012
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Advance
Access Abstracts from NDT - December 20, 2011
• Determination
of Brachial Artery Stiffness Prior to Vascular Access Creation: Reproducibility
of Pulse Wave Velocity Assessment
• Right
Atrial Thrombi Complicating Hemodialysis Catheters. A Meta-Analysis of
Reported Cases and a Proposal of a Management Algorithm
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Fishing
for Patency in Hemodialysis Grafts (Fish Oil Study) - (Registration
required, but free.) Article from Medscape Nephrology. - December 3, 2011 |
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Early
View Abstracts from Seminars in Dialysis - December 16, 2011
• Catheter
Dysfunction: The Role of Lock Solutions
• Vascular
Access Considerations for Therapeutic Apheresis Procedures
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Dialysis
Unplugged - Fistula First: The Naysayers Were Wrong - Posting by Dr.
Jay Wish on The Kidney Doctor. - December 3, 2011
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Early
View Abstracts from Seminars in Dialysis - December 9, 2011
• Angioplasty
and Stenting of a Jugular-Carotid Fistula Resulting from the Inadvertent
Placement of a Hemodialysis Catheter: Case Report and Review of Literature
• Partial
Aneurysmectomy is Effective in Managing Aneurysm-associated Complications
of Arteriovenous Fistulae for Hemodialysis: Case Series and Literature
Review
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A
Comparison of the NiagaraTM and Dolphin® Catheters for Continuous
Renal Replacement Therapy - Article in Press Abstract from The International
Journal of Artificial Organs - December 12, 2011
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Latest
Scientific Journal Articles on Vascular Access - list compiled by RenalWEB's
Journal
Watch |
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Latest
issue of the Journal
of Vascular Surgery |
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The
Gold Standard - A quarterly newsletter from the Fistula First Breakthrough
Iniiative (web site) |
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Atlas
of Dialysis Vascular Access - 76-slide presentation from Wake Forest
University. - December 2010 |
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AV
Access information page and Please
be careful with my veins - An information page to be given to
nurses or phlebotomist who are about to start an IV or draw blood on dialysis
patients (1998). All information
from the Nephron Information Center web site. |
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Buttonhole
Slideshow - Slide presentation by Lynda Ball from the Northwest Renal
Network - June 2010 |
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Using
the Buttonhole Technique for Your AV Fistula (pdf format
requires Adobe Acrobat reader) from the Northwest Renal Network web
site |
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Cannulation
of the Arteriovenous Fistula (AVF) video from the Fistula First web
site |
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Caring
For & Developing Your New Fistula (pdf) from the Northwest Renal
Network web site |
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'Change
Concepts' from Fistula First
•Routine
CQI review of vascular access
•Timely
referral to nephrologist
•Early
referral to surgeon for "AVF only" evaluation and timely placement
•Surgeon
selection based on best outcomes, willingness, and ability to provide
access services
•Full
range of appropriate surgical approaches to AVF evaluation and placement
•Secondary
AVF placement in patients with AV grafts
•AVF
placement in patients with catheters where indicated
•Cannulation
training for AV fistulas
•Monitoring
and maintenance to ensure adequate access function
•Education
for caregivers and patients
•Outcomes
feedback to guide practice
•Modify
hospital systems to detect CKD and promote AV fistula planning and placement
•Support
patient efforts to live the best possible quality of life through self-management
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Clinical
Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related
Infection: 2009 Update by the Infectious Diseases Society of America
- full-text article from Clinical Infectious Diseases. - July 1, 2009 |
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Creating
AV Fistulas in All Eligible Hemodialysis Patients from the University
of Oklahoma College of Medicine web site |
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ESRD
National Vascular Access Improvement Initiative (NVAII) - Fistula First
Project from the ESRD Network of Texas, Inc web
site |
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Fistula
First web site, Fistula
First Data, 2009
Annual Report, and Patient
Section |
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Fistula
First Inservice Module (pdf format requires Adobe Acrobat reader) from the ESRD Mid-Atlantic Renal Coalition
web site |
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Fistula
First: Patient Educational Flyer
(pdf) lists pros and cons of a fistula, graft, and catheter |
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Fistula
First Project news summary from RenalWEB |
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Frequently
Asked Questions about the ArterioVenous Fistula (pdf) and Fístula
Arteria Venosa En Español (pdf) from the Northwest Renal Network
web site |
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Guidelines
for the Prevention of Intravascular Catheter Related Infections
from Morbidity and Mortality Weekly Report
web site - August 2002 |
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Helping
the Patient Make Healthy Fistula Choices - educational Web-EX Series
from The Renal Network, Inc. - June 29, 2009 |
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Just
the Facts: Vascular Access and Información
esencial: Acceso vascular (pdf format requires Adobe Acrobat Reader) from the Life Options web
site |
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Keeping
Your Access Uncovered - (2-page pdf) from the Northwest Renal Network |
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Let's
Talk About Fistulas - 3 minute video from the Fistula First Breakthrough
Iniiative (web site) |
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The
natural history of autologous fistulas as first-time dialysis access in
the KDOQI era - full text article from the Journal of Vascular Surgery
- February 2008 |
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Preparing
the Vascular Access for Cannulation (pdf format requires
Adobe Acrobat reader) from the Northwest Renal Network web
site |
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Prevent
Dangerous Hemodialysis Catheter Disconnections article from FDA's Center
for Medical Devices |
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Protocol
for the Referral and Placement of Permanent Vascular Access (pdf
format requires Adobe Acrobat reader) from the ESRD Network 11
web site |
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Revised
European Best Practice Guidelines for Hemodialysis - Vascular Access Part
I (pdf) and Revised
European Best Practice Guidelines for Hemodialysis - Vascular Access Part
II (pdf) - guidelines endorsed by the European Renal Association-European
Dialysis and Transplant Association (ERA-EDTA) |
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Example
Self-Cannulation of Vascular Access Procedure (requires
Microsoft Word™) from the National Vascular Access Improvement
Initiative (NVAII) Tools and Resources Sub-committee |
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3
Ps for Vascular Access Success - Handbook from The Renal Network, Inc.
and slides
- November 2010 |
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Understanding
Your Hemodialysis Access Options - 16-page brochure outlines the various
access devices available for patients on hemodialysis from the American
Association of Kidney Patients web site. |
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Vascular
Access quality improvement from The Renal Network (ESRD Network 9/10)
web page |
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Vascular
Access - A Lifeline for Dialysis - new module at the KidneySchool™. |
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Vascular
Access: Before During & After - (pdf) education tool from Network
8 web site |
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Vascular
Access Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’
Association |
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Vascular
Access for Hemodialysis from the NIDDK Publications Online for Kidney
Disease |
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Vascular
Access for Hemodialysis (pdf) from the Northwest Renal Network web
site |
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Vascular
Access for Hemodialysis+ power point presentation from the American
Nephrology Nurses’ Association |
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Vascular
Access Patient Education "Electronic Notebook" (pdf
format requires Adobe Acrobat reader) from the ESRD Network # 14 web
site |
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Venous
Needle Dislodgement - How To Minimize the Risks - (pdf) poster from
the EDTNA/ERCA |
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Vital
Signs: Central Line--Associated Blood Stream Infections --- United States,
2001, 2008, and 2009 - Article from the CDC's Morbidity and Mortality
Weekly Report. The article mentions the word "dialysis" 42 times.
- March 2011
"The majority of central line--associated blood stream infections
are now occurring outside of ICUs, many outside of hospitals altogether,
especially in outpatient dialysis clinics."
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