| Vascular Access | Description | Uses and advantages | Disadvantages |
| Arteriovenous (AV) Fistula and AV Graft | |||
| AV Fistula | -It has the highest patency, and -Lowest risk of bacteremia. |
It takes a long time to mature (2-6 months). | |
| AV Graft | Easier to create than an AF fistula. Maturation time is 2-3 weeks. |
Has poor primary patency and often requires thrombectomy or angioplasty. | |
| Central Catheters -There are two main types of hemodialysis catheters: non-tunneled or tunneled. – Both are used as a bridge while waiting for maturation of the AV Fistula / AV graft or for a transplant. They are also used for patients who have exhausted other forms of access or when the risk of complications of AV access is excessive. -Dialysis catheters are typically inserted into the jugular or femoral vein. The subclavian vein should be avoided unless no other option is available. -Catheters don’t need time to mature, they can be used immediately. |
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| Non-tunnelled Catheter Duration: < 1 week is best. At most 2 weeks. |
-Are shorter in length and are relatively stiff, which facilitates insertion. -Can be triple-lumen with one additional lumen between the red and blue dialysis lumens that can be used for IV Fluids and blood draw. |
-Are preferred for immediate and acute hemodialysis. –When access is needed for < 2 weeks. |
-Has Icreased risk of infection. Because of that, the duration is limited to < 2 weeks for IJ catheters. Femoral catheters are usually limited to a single treatment in ambulatory patients and < 1-week use in bed-ridden hospitalized patients. |
| Tunneled Catheter Duration: Up to 1 year or more. |
“Are made of soft polymer catheters and have one to two cuffs around the catheter to promote tissue ingrowth and adherence, and to minimize the risk of catheter infection by limiting migration of bacteria along the catheter from the exit site.” -Is generally double lumen. |
-When access is needed for ≥ 2 weeks. -Have faster flow rates during HD vs. non-tunneled catheters because they have a larger luminal diameter. |
-Lower rates of infection vs. non-tunneled catheters. |
**If you are going to place a catheter, it’s best to place a tunneled catheter. It’s hard to know if you will need it for more than two weeks or not. Only used non-tunneled when you can’t put a tunneled catheter because of the patient’s status.
“Dialysis catheters usually have at least two lumens attached to two ports (blue and red colored). By convention, the red port identifies the “arterial” lumen that draws blood from the body (proximal/side opening[s]) and the blue port identifies the “venous” lumen for return of blood from the dialysis machine to the patient (the distal opening[s]).” UTD
Image from Wikipedia