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Vascular access remains the Achilles heal of haemodialysis. Fistulae are the most effective means of access, but are subject to thrombosis and infection. Bidirectional single-line systems are a useful alternative to shunting in the short-term management of acute renal failure. Attention must be given to the insertion of a patient's first fistula, and to the subsequent care of these access sites.
Vascular access remains the Achilles heal of haemodialysis. Fistulae are the most effective means of access, but are subject to thrombosis and infection. Bidirectional single-line systems are a useful alternative to shunting in the short-term management of acute renal failure. Attention must be given to the insertion of a patient's first fistula, and to the subsequent care of these access sites.