There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
One hundred twenty-eight hemodialysis patients and 64 medical personnel consisting
of dialysis nurses and technicians, hemodialysis access surgeons and nephrologists
were surveyed about their preferences and concerns in regard to the hemodialysis vascular
access. The access preferred by physicians was the A-V fistula in the lower arm. In
contrast, the access preferred by dialysis nurses and technicians was the polytetrafluoroethylene
(PTFE) graft in the lower arm. Patients desired a superficial access in the forearm
which was easy to cannulate, had minimal effect on their appearance, provided quick
hemostasis after dialysis and enabled arm comfort during dialysis. Physicians felt
the most significant concerns about the access were thrombosis and infection. Nurses
and technicians ranked difficult cannulation and insufficient access blood flows that
prohibited dialysis adequacy as their major problems. For patients the most common
problem was pain during needle insertion. This survey concluded that the A-V fistula
remains the access of choice. However, appropriate maturation of the fistula must
occur before needle insertion is attempted. An immature fistula is difficult to cannulate,
has fragile veins resulting in blood leakage around the needle infiltrating the subcutaneous
tissues and has inadequate blood flows for successful dialysis. Patients who are introduced
to dialysis with inadequate access function or access failure from either an A-V fistula
or a PTFE graft have increased morbidity, inadequate dialysis and enhanced anxiety
about dialysis treatments. To increase the success and acceptance of A-V fistulas
in hemodialysis patients it is incumbent upon the nephrologist to protect the future
access arm from damage to the vasculature and to allow for fistula maturation before
cannulation. Surgical protocols must improve the appropriate selection of a fistula
or PTFE graft for various age groups and disease categories. Better patient preparation
and selection of the proper access type for each patient will enhance early access
function and subsequent access survival.