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Right Access, Right Time: How Nurses Can Advocate for Best Practice.

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Arteriovenous fistulas (AVFs) are the preferred hemodialysis access due to lower infection and thrombosis rates. Promoting AVF use is crucial for effective end-stage kidney disease treatment and patient outcomes.

Keywords:
arteriovenous fistulaarteriovenous graftend stage kidney disease (ESKD)hemodialysis catheter

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Nursing Practice

Background:

  • Hemodialysis necessitates vascular access via arteriovenous fistula (AVF), arteriovenous graft (AVG), or hemodialysis catheter.
  • AVFs demonstrate superior outcomes with lower infection and thrombosis rates compared to AVG or catheter access.
  • Despite evidence, a significant majority of patients initiate hemodialysis with less optimal catheter access.

Purpose of the Study:

  • To review the types and indications of vascular access for hemodialysis.
  • To highlight the benefits of AVFs as the access of choice.
  • To explore the role of nephrology nurses in promoting evidence-based AVF utilization.

Main Methods:

  • Literature review of hemodialysis access types, indications, and outcomes.
  • Analysis of infection and thrombosis rates for AVF, AVG, and catheter access.
  • Discussion of nursing advocacy for best-practice hemodialysis access.

Main Results:

  • AVFs are associated with the lowest infection and thrombosis rates.
  • Less than 17% of patients have a functional AVF at the initiation of hemodialysis.
  • Hemodialysis catheters are frequently used initially, despite higher associated risks.

Conclusions:

  • AVFs are the optimal vascular access for hemodialysis, offering the best clinical outcomes.
  • Nephrology nurses play a vital role in advocating for and promoting AVF use.
  • Increased AVF utilization can improve the effectiveness and safety of hemodialysis treatment.