Access to the vasculature is required for hemodialysis in order to circulate the patient's blood through the dialysis extracorporeal circuit. Possible complications for all forms of vascular access include thromboses and infection.
- Arteriovenous fistula (AVF) - A vein is arterialized via a surgically created anastamosis between an artery and a vein. This increased blood flow and pressure through the more superficial vein leads to dilatation of the vein, allowing access via large bore needles in order to achieve blood flow through the extracorporeal circuit of the hemodialysis machine.
- Arteriovenous graft (AVG) - A graft, usually synthetic but possibly a biologic, is surgically interposed between an artery and vein to provide access to the vasculature for hemodialysis.
- Central venous catheter (CVC) - A synthetic, large, double lumen catheter, available in various diameters, is aseptically inserted into a large, high flow central vein to provide access to the vasculature. There are two types of CVCs: non-tunneled, non-cuffed catheters (NCC) and tunneled, cuffed catheters (TCC).
- NCC (sometimes referred to as "temporary catheter"): The point of catheter entry passes directly to the central vein, terminating at or near the heart or one of the great vessels. Placement must be confirmed by X-ray or fluoroscopy prior to use. Intended for use for no more than one week.
- TCC (sometimes referred to as "Perm-cath" or "permanent catheter"): The catheter is tunneled under the skin before entry into the central vessel, terminating at or near the heart or one of the great vessels. The cuff on the catheter fosters integration with tissue to stabilize it and prevent dislodgement and serves as a barrier for microorganism migration.
Deaver, K. & Counts, C.S. (2015). Vascular access for hemodialysis. In C.S. Counts (Ed.), Core curriculum for nephrology nursing: Module 3. Treatment options for patients with chronic kidney failure (6th ed., pp. 167-226). Pitman, NJ: American Nephrology Nurses' Association. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2014). Vascular access for hemodialysis. Bethesda, MD: Author. Retrieved from: http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/vascular-access-for-hemodialysis/Pages/index.aspx