The creation and maintenance of functioning vascular access along with the associated complications constitute the most common cause of morbidity, hospitalization, and cost in patients with end-stage renal disease. Vascular access for dialysis can be accomplished via arteriovenous fistula or percutaneous catheter. A peritoneal access can be made use of, too. An organized monitoring approach that includes regular assessment of the clinical parameters of the access and adequacy of the dialyses should be implemented in every dialysis centre. Such a proactive approach can be expected to reduce the incidence of thrombosis and increase patency. Data should be tabulated and tracked within each dialysis centre as part of a quality assurance/continuous quality improvement (QA/CQI) programme. Central vein cannulations can be carried out under ultrasonographic guidance, too. In fact, the NFK-DOQI committee recommends routine real-time ultrasound-guided insertion to reduce insertion-related complications.
Scripta Scientifica Medica 2012; 44(2): 15-18.
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