Hemodialysis Access

What is hemodialysis access?

Man made fistula or graft that allows for blood to be cleansed in patients with end stage renal disease

What are the types of of hemodialysis access?

1. AVF (arterial-venous fistula)

2. Graft

3. Central venous catheter

What is the most effective and durable mode of dialysis access?

Surgically creating an AV fistula (AVF)

Which dialysis access method does not clot as easily as the others?

AV fistula (AVF)

What is a hemodialysis access fistula (AVF)?

Man made connection of one artery and one vein in lower arm to allow for repeated access for each dialysis session

What is the preferred site to create an AVF for hemodialysis access?

Forearm connecting radial artery with cephalic vein at wrist or radiocephalic fistula

What is another name for a radiocephalic fistula?

Bressica-Cimino fistula

What is the second most preferred site to create an AVF for hemodialysis access?

Between brachial artery and cephalic vein at antecubital fossa or elbow

What is the third most preferred site to create an AVF for hemodialysis access?

Brachial artery connected to basilic vein in upper arm

What is the minimum flow volume for satisfactory hemodialysis?

500 mL/min

What is a normal flow volume in a mature clinically functional AVF?

900-2,500 mL/min

What flow pattern is expected for arterial inflow of an AVF/AVG?

Low resistive

How soon after creation can a fistula be used for hemodialysis access?

Several months for fistula to form and be used for access

What are the complications of a hemodialysis access fistula (AVF)?

1. Infection at site of access

2. Clot formation (thrombosis)

What is a hemodialysis access graft (AVG)?

Synthetic tube implanted under skin in arm that becomes an artificial vein used for blood access when a person has very small veins

How soon after creation can a hemodialysis access graft (AVG) be used?

Soon as 1 week after placement (NO DEVELOPMENT)

What are complications of a hemodialysis access graft (AVG)?

More problems with clotting or infection and need to be replaced sooner

What is the most common type of graft used for hemodialysis?

Polytetrafluoroethylene (PTFE) or goretex graft

What are the most common hemodialysis access grafts (AVG)?

1. Forearm loop graft

2. Upper arm straight graft

3. Axillary loop graft

4. Thigh graft

What are the minimum vessel sizes required for hemodialysis access fistula (AVF)?

1. Vein > 25 mm

2. Artery > 20 mm

What are the minimum vessel sizes required for hemodialysis access graft (AVG)?

1. Vein > 40 mm

2. Artery > 20 mm

What is a venous catheter used for hemodialysis access?

Tube or catheter usually placed in a vein in neck, chest, or groin used until permanent access is developed

Why is a venous catheter not typically used for permanent hemodialysis access?

1. Clogs easily

2. Infection

What are indications for hemodialysis access evaluation?

1. Pre-op assessment

2. Elevated pressures during dialysis

3. Puncture problems

4. Perigraft fluid or mass

5. Distal limb ischemia

6. Poor dialysis

What does the term “inflow” refer to?

Flow into legs from iliacs

What does the term “outflow” refer to?

Flow into legs from common femoral arteries

What does the term “run off” refer to?

Flow into calves