Hemodialysis Access Care

Hemodialysis requires reliable access to the bloodstream at a flow rate high enough to clear solutes and remove fluid. The access is not simply a route for needles or tubing; it is the patient’s lifeline during treatment. Loss of access can mean urgent catheter placement, missed dialysis, infection risk, and hospitalization. An arteriovenous fistula (AVF) is a surgically created connection between an artery and a vein, usually in the arm. Arterial pressure enlarges and strengthens the vein over time so it can tolerate repeated cannulation. When the patient’s vessels are suitable, an AVF is the preferred access for chronic hemodialysis because it has lower infection and thrombosis risk than other access types. An arteriovenous graft (AVG) connects an artery and vein using synthetic material. A graft can often be used sooner than a fistula, but the artificial surface increases the risk of infection and clot formation. Grafts are more likely than fistulas to develop stenosis at the venous outflow. A central venous catheter (CVC) is inserted into a large central vein and provides immediate access. It is useful when dialysis...