Rationale for Guideline for "Preferred Vascular Access"

Preferred vascular access for hemodialysis

Contribution from European Best Practice Guidelines Committee

The current 2002 version of the European Best Practice Guidelines do not have a section specifically for vascular access. In this 2002 version, there is a section on haemodialysis-associated infection which recommends;

To prevent infection, vascular access should be a native fistula whenever possible. (Evidence level: B)

The 2006 version, currently in preparation, will have a section specifically for vascular access.

Rationale: Patients with a PFTE graft were found to have a 29–33% greater risk of bacteraemia than patients with a native fistula [1,2] . In a standardized surveillance of HD vascular access systems, 4.6 infections per 1000 dialysis sessions (ds) were identified. This rate was 2.5 for permanent fistulae or grafts, 3.6 for permanent catheters and 18.4/1000 ds for temporary catheters [3].

References:

Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter retrospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 1998; 9: 869–876
Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 1999; 55: 1081–1090
Stevenson KB, Adcox MJ, Mallea MC, Narasimhan N, Wagnild JP. Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center. Infect Control Hosp Epidemiol 2000; 21: 200–203

Prepared on behalf of the European Best Practice Guidelines Committee by James Tattersall (Sub-group Chairman)