For patients with chronic kidney disease, vascular access plays an important role in the delivery of care. For many, this is seen as their lifeline as it is the route through which they receive their dialysis treatment.
Different types of vascular access
Vascular access, the route through which treatment is delivered to patients receiving haemodialysis, can be administered in different forms. Typically, there are three different ways to create vascular access.
The most common vascular access is known as an arteriovenous fistula. This is a connection that is made by joining a vein onto an artery in your arm, creating a large blood vessel that can be needled regularly for use during haemodialysis treatment. An arteriovenous graft is a synthetic tube that is placed into the body, usually made from woven fabric. The last type of vascular access administered to patients is a central venous catheter or line, which tends to be used if you are unable to receive a fistula or a graft. Catheters are in effect, tubes made from plastic. This tube is placed under the skin and connected to a big vein in the body.
How to look after your vascular access
Preservation of your vascular access is one of the most important parts of your treatment. Most patients will most likely only have one vascular access at any given time.
Patients are encouraged to protect their vascular access at all costs due to the risks of severe complications.
- Do not let anyone touch your vascular access: If you have a graft or a fistula in your arm, it’s imperative that you don’t let anyone other than your dialysis nurse perform procedures on that arm. This includes procedures such as taking your blood pressure or having blood tests.
- Be aware of the look and feel: It’s important that you know the difference between the look and feel of your vascular access when you’re on dialysis and when you’re not on dialysis. This includes knowing what the shape looks like and what it feels like when you touch it. A fistula should pulse and have a rhythmic “buzz” often referred to as a thrill.
- Be alert of changes to your skin: You need to be aware of what the skin looks like over your vascular access. Be alert to any changes to the skin, i.e., if you notice the skin becoming thinner, going red, or any discharge, let your nurse know immediately as you may be at risk of infection.
 |
A common and serious complication that you may come across with your vascular access is infection. Bleeding is another severe complication that can occur if your vascular access is not cared for.
A vascular line is the most prone to infection, as they are made of plastic, and they are externally exposed as they come out of the skin. If your vascular access is a line, it’s important to keep in mind that there will always be a route for germs to enter the body.
Vascular access can also sometimes get blocked with blood clots. If this occurs, there’s a possibility that it may require a treatment to remove or dissolve the clot, or in some cases, you may have to have a new access placed.
---
We are currently working on a project with the Parent NHS Renal Unit, looking at whether monitoring temperature during haemodialysis helps to identify changes in dialysis access blood flow in Fistulas and Grafts and if such an intervention can be incorporated within the vascular access management pathway of an individual unit. We hope to publish a report detailing the project’s outcomes and how the findings will further progress the standard of vascular access administered on patients.