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Overview of hemodialysis access and assessment
Rohan Arasu1, Dev Jegatheesan2, Yogeesan Sivakumaran3
1Registrar in the Department of Vascular Surgery at Fiona Stanley Hospital and Associate Lecturer in the Faculty of Medicine at the University of Queensland in Brisbane, Australia.
Insights
Family physicians can improve hemodialysis (HD) patient outcomes by assessing vascular access, including arteriovenous fistulas and grafts. Early detection of complications ensures timely intervention, maintaining access function and patient quality of life.
Area of Science:
- Nephrology
- Vascular Surgery
- Family Medicine
Background:
- Hemodialysis (HD) requires reliable vascular access.
- Choosing the appropriate vascular access is crucial for patient care.
- Complications can significantly impact patient health and access longevity.
Purpose of the Study:
- To offer family physicians an evidence-based guide to hemodialysis vascular access methods.
- To establish a framework for clinical assessment of hemodialysis access.
- To emphasize the role of family physicians in managing vascular access.
Main Methods:
- A comprehensive MEDLINE literature search was performed.
- Keywords included arteriovenous fistula, arteriovenous graft, central venous catheter, and hemodialysis.
- English-language articles published from January 1995 to September 2021 were reviewed.
Main Results:
- The primary permanent vascular access options for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters.
- A patient-centered approach is essential for selecting the optimal access type.
- Common complications include thrombosis, stenosis, steal syndrome, and aneurysms.
Conclusions:
- Family physicians are vital in assessing and monitoring HD vascular access.
- Clinical assessment can identify failing access and complications early.
- Prompt intervention preserves access function, extends longevity, and enhances patient quality of life.
Objective:
To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical assessment of HD access.
Sources Of Information:
A MEDLINE literature search was conducted using the MeSH terms arteriovenous fistula, arteriovenous graft, central venous catheter, and hemodialysis (or haemodialysis), including all relevant English-language articles published between January 1995 and September 2021.
Main Message:
The main types of permanent vascular access for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters. A pragmatic, patient-centred approach is required when choosing the type of access for an individual. Common complications of vascular access creation include thrombosis, central venous stenosis, dialysis access steal syndrome, and arteriovenous fistula aneurysms.
Conclusion:
Family physicians play an important role in the clinical assessment and monitoring of HD vascular access. A thorough clinical assessment can detect a failing arteriovenous fistula and any associated complications, which can allow for prompt investigation and intervention to restore functionality, maintain access longevity, and improve patient quality of life.
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