Vascular access for hemodialysis

Establishing and maintaining good vascular access for blood purification is the primary condition to ensure smooth blood purification and adequate dialysis. Vascular access is also the “lifeline” for long-term maintenance hemodialysis patients. According to the needs of the patient's condition and blood purification methods, vascular access is divided into emergency dialysis (temporary) vascular access and maintenance (permanent) vascular access. The former mainly uses central venous indwelling catheters or direct puncture of arteries and veins, while the latter uses arteriovenous fistulas or long-term central venous indwelling catheters. An ideal vascular access should have sufficient blood flow during hemodialysis, be easy to puncture, be durable, and have few complications. When designing vascular access, the choice of temporary or permanent vascular access should be based on the patient's primary cause of renal failure, degree of reversibility, age, patient unit and hospital conditions. When simple acute renal failure or chronic renal failure deteriorates rapidly, and the arteriovenous fistula is immature, temporary vascular access should be selected. Percutaneous femoral vein, subclavian vein or internal jugular vein indwelling catheters can be used to establish vascular access. . Permanent vascular access should be selected for chronic renal failure, and arteriovenous fistulas or vascular grafts can be used. Long-term central venous indwelling catheters can also be used when vascular conditions are poor. It should be noted that before patients with chronic renal failure enter dialysis, clinicians should properly protect the blood vessels of both upper limbs and forearms. Avoiding repeated punctures is the most important step to ensure long-term vascular access without complications.