Hemodialysis Access Care

Hemodialysis requires reliable access to the bloodstream at a high flow rate. The three main access types differ in durability, infection risk, and how they are handled. 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, creating a vessel that can tolerate repeated cannulation. When the patient has suitable vasculature, an AVF is the preferred access for chronic hemodialysis because it generally has fewer infections and thrombotic complications than other options. An arteriovenous graft (AVG) connects an artery and vein with a synthetic conduit. A graft can often be used sooner than a fistula, but the foreign material increases the risks of infection, stenosis, and thrombosis. It is also cannulated with dialysis needles. A central venous catheter (CVC) is placed into a large central vein, commonly the internal jugular vein, and is used when immediate access is needed or when a fistula or graft is not available. A catheter is not repeatedly needled, but it creates a direct route for skin...