Vascular access for hemodialysis

Medicina Fluminensis

Vujičić, Božidar¹  Maleta, Ivica¹  Ćuruvija, Darko³  Rački, Sanjin¹  Mesaroš Devčić, Iva² 

[1] Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka;Poliklinika za hemodijalizu “Fresenius Medical Care”, Delnice;Zavod za torakovaskularnu kirurgiju, Klinika za kirurgiju, KBC Rijeka

关键词: arteriovenous fistula;    arteriovenous graft;    catheter for hemodialysis;    hemodialysis;    vascular access;   

DOI  :  

学科分类：医学（综合）

来源: Medicina Fluminensis

【 摘 要 】

In patients with end-stage chronic renal disease who are treated with regular hemodialysis,
the vascular access is mandatory. It can be achieved through the catheter for
hemodialysis or through construction of arteriovenous (AV) fistula and arteriovenous (AV)
graft. Vascular access may be temporary or permanent. Temporary access to the bloodstream
includes the appropriate placement of a catheter into one of the central veins (internal
jugular, subclavian or femoral). Puncture is performed percutaneously, and it is recommended
that the vein is previously visualised by ultrasound. For temporary access,
non-tunneled catheters are commonly used. Permanent access to the bloodstream can be
achieved using the AV fistula or AV graft, and so-called tunneled or, uncommonly used, nontunneled
catheter into one of the central veins. Complications of the vascular access are numerous.
Complications of the AV fistula and AV graft are stenoses, thromboses, aneurysms,
pseudoaneurysms, cardiovascular complications, infections, and peripheral ischemia of the
distal extremity. Complications of catheter for hemodialysis include hematoma at the site of
puncture, accidental arterial puncture, inadequate position of the catheter, pneumothorax,
hematothorax, hematopericard, thrombosis and infection. For catheter locking at the time
of disuse heparin is used most commonly, but recently citrate solutions of different concentrations
are being used as well. Adequate catheter care will allow its long-term use.

【 授权许可】

Unknown