In a person interested in hemodialysis when and what should be done to facilitate the timely placement of a functional vascular access and why is that important?
For a patient who is opting for hemodialysis, vascular access should be placed early enough so that the vascular access is usable when hemodialysis is initiated.
Patients and their health care providers should be instructed to avoid venipuncture above the hands, particularly in the nondominant arm, to preserve the veins for arteriovenous fistula (AVF) formation. An AVF takes several months to mature and will fail to mature in approximately half the cases.
Arteriovenous grafts will be able to be used 2 to 3 weeks after placement. Peritoneal dialysis requires sufficient time for not only catheter placement and healing (approximately 2 to 4 weeks) but also the training that will be required for the patient and his or her family prior to the full initiation of the therapy.
Having a patient’s vascular access or peritoneal access ready when it is necessary to initiate renal replacement therapy is important to avoid placement of an intravenous catheter and hospitalization to initiate hemodialysis.
Catheters have increased risk of infection and mortality compared with AVF.
