A quality improvement program for hemodialysis vascular access.
The effective delivery of dialysis requires repeated reliable access to the central circulation capable of providing rapid extracorporeal blood flow. Unfortunately, this access to the circulation continues to be the "weak link" in the effective delivery of long-term hemodialysis therapy. This will likely become an even greater problem in the future as increasing numbers of patients with limited access sites secondary to advanced age and atherosclerosis enter the end-stage renal program. Therefore, the preservation of these limited vascular access sites is imperative. Vascular access thrombosis is the leading cause of graft loss and venous stenosis is the major cause of graft thrombosis. Early detection of venous stenosis through careful inspection of the graft combined with measurements of venous outflow pressure and urea recirculation can identify venous access stenosis. Identification of these lesions combined with preemptive repair improves dialysis efficiency and preserves vascular access. When these techniques are used, a dramatic impact on dialysis fistula patency and function can be seen.
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