Preferred Vascular Access |
Guideline Organization |
Recommendation (Evidence Level) |
Evidence |
Comments |
CARI-Australia
2000 |
A native AV-fistula should be preferred to a graft (Level B) |
Vascular access
9. Choice of type of access |
PTFE is the preferred material for a graft
Graft configuration is not a factor influencing patency |
CSN-Canada
2006 |
• The preferred type of vascular access is radio-cephalic native vessel arteriovenous fistula (Grade C) |
Chapter 4: Vascular Access
p 16 of 27 PDF pages |
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EBPG-Europe |
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KDOQI-US
Vascular Access
2006 |
• The order of preference for placement of fistulae in patients with kidney failure who choose HD as their initial mode of KRT should be (in descending order of preference):
- 2.1.1 Preferred: Fistulae. (B)
- 2.1.1.1 A wrist (radiocephalic) primary fistula. (A)
- 2.1.1.2 An elbow (brachiocephalic) primary fistula. (A)
- 2.1.1.3 A transposed brachial basilic vein fistula: (B)
- 2.1.2 Acceptable: AVG of synthetic or biological material, such as: (B)
- 2.1.2.1 A forearm loop graft, preferable to a straight configuration.
- 2.1.2.2 Upper-arm graft.
- 2.1.2.3 Chest wall or “necklace” prosthetic graft or lower-extremity fistula or graft; all upper-arm sites should be exhausted.
- 2.1.3 Avoid if possible: Long-term catheters. (B)
- 2.1.3.1 Short-term catheters should be used for acute dialysis and for a limited duration in hospitalized patients. Noncuffed femoral catheters should be used in bed-bound patients only. (B)
- 2.1.3.2 Long-term catheters or dialysis port catheter systems should be used in conjunction with a plan for permanent access. Catheters capable of rapid flow rates are preferred. Catheter choice should be based on local experience, goals for use, and cost. (B)
- 2.1.3.3 Long-term catheters should not be placed on the same side as a maturing AV access, if possible. (B)
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Guideline 2. Selection and Placement of Hemodialysis Access |
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UK-Guidelines
2007 |
- The preferred mode of vascular access for HD patients is a native arteriovenous fistula.
- There should be enough dedicated theatre sessions for access surgery to provide one session per week for every 120 patients on dialysis. With this level of access surgery provision no patient on dialysis, including those patients who present late, should wait more than four weeks for fistula construction.
- At least 65% of patients presenting more than three months before initiation of dialysis should start HD with a usable native arteriovenous fistula.
- As few HD patients as possible should rely on central venous catheters for vascular access. As an audit measure less than 20% of patients on long-term HD should use tunneled or non-tunneled central venous catheters as the form of vascular access.
- Cuffed, tunneled double-lumen central venous catheters are preferred if temporary vascular access is likely to be needed for more than 3 weeks. Non-cuffed double-lumen catheters may be used if temporary vascular access for haemodialysis is predicted to be required for less than 3 weeks. |
Module 3a: Haemodialysis- 7.0 Vascular Access |
Al dialysis units should collect data on infection of grafts and catheters
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