Vascular access is needed for dialysis to provide sufficient blood flow. There are temporary and permanent options. Temporary catheters placed in the neck or leg can be used for immediate dialysis needs or while a permanent access matures. Permanent options include tunneled catheters or arteriovenous fistulas/grafts. Arteriovenous fistulas have the best outcomes with reduced infection risk and longer survival, so they should be planned 6-12 months before anticipated long-term dialysis need. Catheter complications like infection and clotting can be prevented through proper care of the access site and reporting any issues immediately.

1. VASCULAR ACCESS
CARE
Dialysis Unit, Christian Medical College

2. NEED FOR VASCULAR ACCESS
• To facilitate sufficient and
constant blood flow for dialysis.
• To have effective dialysis.

3. TYPES
TEMPORARY VASCULAR ACCESS
Central venous catheters - uncuffed, non tunneled
double lumen catheters placed into the any of the
central veins of neck, chest or leg, providing access
for dialysis.
Sites
Jugular Venous Catheter - To be removed within
21 days
Femoral Venous Catheter – To be removed in 7
days.

4. Permanent Vascular Access
1. Cuffed tunneled catheter placed into
Jugular vein or subclavian vein
• Can be in place for up to 5yrs.
• Removed early in case of any catheter related
infection
2. Arterio Venous Fistula
3. Arterio Venous Graft

5. CATHETERS
Temporary Jugular Temporary Femoral
Permanent catheter

6. Cost
• Temporary: Jugular venous catheter-RS 6765/-
• femoral venous catheter
• Permanent: Perm cath –RS 17755/-
• Dressing material - RS 240/-
• Mupirocin ointment - RS 105/-

7. WHEN IS A TEMPORARY CATHETER IDEAL TO
HAVE?
• For immediate initiation of dialysis in case of
acute or temporary problems as increase in urea,
creatinine, potassium levels, poisons, toxins,
fluid.
• Until maturation of AV fistula in Kidney Failure.
• Failure of other permanent access options
• Short wait before Renal Transplant

8. BEST VASCULAR ACCESS OPTION
*ARTERIO VENOUS FISTULA
Why…?
• Delivers adequate blood flow for dialysis.
•Reduced chance of infection, sepsis, thrombosis
•Longer survival
WHEN TO PLAN FOR FISTULA
At an early stage of Chronic Kidney Disease (stage 3 or
4 itself)
To create Fistula 6-12 months prior to the anticipated
need

9. COMPLICATIONS OF CATHETER
• Catheter related infections
• Thrombus formation-clot in blood vessel
• Venous Stenosis -Narrowing of vessel
• Displacement of Catheter

10. HOW CAN YOU PREVENT CATHETER
RELATED COMPLICATIONS
• Avoid wetting the catheter site.
• Keep the skin around the catheter site
clean and dry
• Make sure that catheter site dressing
is changed with every dialysis or when
wet.
• Avoid unnecessary handling of the
catheter

11. • Take showers daily (Men- to shave
facial & chest hair)
• While traveling cover the neck with
towel or dupatta.
• Avoid injury or undue pressure over
neck, chest.
REPORT IMMEDIATELY
• Fever pain, bleeding, pus discharge,
redness, loose catheter, Sutures gave
way.