Vascular access

Easy access to the circulation is a key component of haemodialysis. The ideal vascular access (VA) should be easy to use, reliable and have minimal risk to the individual receiving haemodialysis (1).

In the short term, it may be gained by:

• direct cannulation of large vessels - single or double lumen tubes inserted into the subclavian or femoral veins
• external arteriovenous shunts - separately cannulated peripheral artery and vein, interconnected with a loop of silicone tubing. For example, posterior tibial artery connected to the long saphenous vein - a Quinton-Scribner shunt (1,2)

For long term use, UK renal association recommend that all patients with end stage kidney disease who commence haemodialysis should use

• an arteriovenous fistula as first choice
• an arteriovenous graft (prosthetic or biological material) as second choice
• a tunnelled venous catheter placed in a central vein as third choice
• a non-tunnelled venous catheter as an option of necessity (1)

Reference:

• (1) Clinical practice guideline. Vascular access for haemodialysis. UK Renal association