MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

SOME DEFINITIONS BEFORE TALKING ABOUT STEPS FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

1. Arteriovenous Fistula (AVF) – is the result of a surgical creation of an anastomosis between an artery and a vein, which allows arterial blood to flow through the vein, causing venous engorgement, enlargement, and thickening of the venous wall. The arterial limb and anastomosis are never cannulated.
2. Arteriovenous Graft (AVG) – is a biologic, semi biologic or synthetic (such as Gortex or Teflon or Polytetrafluorethylene -PTFE), implanted subcutaneous and interposed between an artery and a vein. Needles are inserted into the graft material in order to remove and return blood during hemodialysis.
3. Central Venous Catheter (CVC) – is a device used on a long- term or short- term basis as circulatory access for hemodialysis. CVC is made of silicone rubber, rigid or semi-rigid material of a varying length and is radio-opaque. A double lumen catheter (Quinton Cath) is most commonly used. This catheter is placed in the internal or external jugular, subclavian or placed percutaneously in the femoral vein.
4. Long-Term CVC (Permcath) – is indicated for patients in whom permanent AV access is no longer possible, or who are waiting for native AV fistula to mature/develop or who are waiting for the creation of permanent AV access. These catheters are usually placed in the internal jugular vein or the subclavian vein and a subcutaneous tunnel is created that allows the catheter to exit the chest wall. There is a dacron cuff on the catheter that will facilitate tissue growth into it to hold the catheter in place and provide a barrier to bacteria growth.

PROPER MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

1. To establish a safe procedure for accessing the patient’s circulatory system using AVF/AVG or CVC access for hemodialysis treatment.
2. To provide effective management to optimize the hemodialysis delivery dose.

1. Hemodialysis access shall only be used for hemodialysis treatment as described in this policy.
2. The use of hemodialysis central venous catheters for other purpose is restricted to circumstances where there is no other alternative to access a vein.

MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS Procedures	Responsible Person/s
Explain to the patient and family members the need for vascular surgery to create AVF or AVG; or a hemodialysis central venous catheter for hemodialysis treatment.	Nephrologist
Complete a written order for creation of AVF or AVG or insertion of a temporary or permanent central venous catheter.	Nephrologist
Contact the Vascular Surgeon and writes a consultation for vascular surgery intervention.	Nephrologist
In the event of malfunction of AV access or clotted AVF, AVG or central venous catheters; the Nephrologist shall assess the patient and contact the Vascular Surgeon.	Nephrologist Vascular Surgeon
Insert temporary central venous catheter for hemodialysis in the ICU. In special cases, the nephrologist may insert the central venous catheter in the Dialysis Unit.	Nephrologist
Insert the hemodialysis permanent central venous catheter (Permcath) in the Cardiac Catheterization Laboratory (CCL) or Operating Room	Vascular Surgeon
Use aseptic technique to access; perform exit-site care and manipulation of the hemodialysis central venous catheter.	Dialysis Registered Read moreInsulin Overview Nurse
Perform catheter care pre or post-hemodialysis treatment on the day of dialysis in the unit.	Dialysis Registered Nurse
For permanent AV access: 1.       Blood pressure or venipunctures are not performed on the AV access limb. 2.       Circular occlusive dressings are not applied on the AV access limb at all times. 3.       Patient is instructed not to wear restrictive clothing that impedes blood flow to the AV access limb	Dialysis Registered Read morePrevention and Management of Medication Errors. Nurse
Give teaching to the patient to care of his/her AVF, AVG, or central venous catheter as follows: 1.  Assess the level of the patient’s knowledge of their hemodialysis access, which includes purpose, description, care, assessment and emergency care. Provide instruction as required, utilizing expertise and knowledge from all members of the renal multidisciplinary team. 2. Teach the patient the importance of good hygiene. 3. Instruct the patient/family member in the care of vascular access and to recognize the signs and symptoms of infection.	Dialysis Registered Nurse
Refer to Patient Teaching Policy about Central Venous Catheter care and Care of AV Graft and AV Fistula.	Dialysis Registered Read moreIV. PREPARATION COMPETENCY CHECK LIST (FOR NURSES) Nurse
Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services.	Dialysis Registered Nurse Nephrologist
Documents assessment, management and patient education of vascular access clearly and legibly on the Focus Charting Sheet.	Dialysis Registered Nurse Nephrologist
Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services.	Dialysis Registered Nurse Read more3 Simple Tips To Improve Your Pharmacy Experience? Nephrologist

REFERENCE FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS 

1. Clinical Practice Guidelines for Vascular Access, National Kidney Foundation
2. Handbook of Dialysis, John T. Daugirdas, Todd S. lng
3. CBAHI 3’“ Edition Standards
4. JClA 5″‘ Edition Standards