Assessing the adequacy of vascular access and its relationship to patient outcome

Hemodialysis requires repeated reliable access to blood vessels capable of providing rapid extracorporeal blood flow. This access to the circulation, termed "vascular access," is currently met by the use of native and synthetic arteriovenous fistulas. Vascular access dysfunction is a leading cause of hemodialysis morbidity and a major contributor to hemodialysis cost. Fistula thromboses and infection are the two leading causes of access failure. This report describes what constitutes adequate vascular access and outlines techniques for decreasing vascular access morbidity. New concepts for dialysis unit-based quality assurance focusing on prevention of access thromboses and infection are emphasized as a means of improving patient outcome. Research initiatives seeking to minimize access complications are proposed.