the problem of vascular access

WURJANTO

UNS MEDICAL FACULTY/DR. MUWARDI HOSPITAL

INTRODUCTION VASCULAR ACCESS

The first preparation before starting regular Dialysis

Which is the site on the body where blood is removed and returned during dialysis

Maximise the amount of blood cleansed during hemodialysis treatment

Vascular access should allow continous high volumes of blood flow

Many possible complications/problem of vascular access

Vascular Access Initiative: Rationale

• Vascular access is one of the most critical issues in improving dialysis quality:– Recent trends:

Access Patency, Morbidity/ Mortality, Costs

– Attributable to: AVF, AVG, Catheters

– Access type is a major determinant of patient outcomes as well as financial outcomes

– Most VA-related morbidity & costs due to grafts & catheters

CONSEQUENCES OF THE PROBLEM :

Vascular access complications account for ~30% Vascular access complications account for ~30% of hospital admissions in chronic HD programs.of hospital admissions in chronic HD programs.22

Infection rate increases with temporary catheter Infection rate increases with temporary catheter use. use. Nearly 75% of HD patients are hospitalized for Nearly 75% of HD patients are hospitalized for vascular access-related problem within 2 years.vascular access-related problem within 2 years.11

Estimates on the cost of hospitalization for Estimates on the cost of hospitalization for vascular access problems range from $2 billionvascular access problems range from $2 billion33 per year to $3 billionper year to $3 billion44, representing 10% to 15% , representing 10% to 15% of Medicare ESRD expenditures. of Medicare ESRD expenditures.

25% of deaths in HD patients are infection-25% of deaths in HD patients are infection-related. related.

PROBLEM OF VASCULAR ACCESS

PROBLEM OF VASCULAR ACCESSPROBLEM OF VASCULAR ACCESS

• THROMBUS AV

FIST

• KINGKIN

TUNNELED

CATH/POSITION

• YUXTA

ANSTOMOSIS

STENOSIS

• VENOUS

CENTRALIS CATH

STENOSIS

• VENOUS STENOSIS

• VENOUS

THROMBOSIS

• ANERISMA ARTERIEL

• STENOSIS ARTERIEL

• INFECTION AV GRAFT

• THROMBUS/NEO

INTIMAL

HYPERPLASIA

• INFECTION

TUNNELED/ AV

FIST/GRAFT

• SEVERE EDEMA

• PATIENT

NERVOUS

• ARTERIEL

VENOUS FRAGILE

(DM)

• INGUINAL

HEMATOMA

• THROMBUS

VASCULAR ACCESS VASCULAR ACCESS COMPLICATIONCOMPLICATION

THROMBOSIS AND INFECTION

VENOUS HYPERTENSION

RADIAL STEAL SYNDROME

ISHEMIC MONOMELIC

NEUROPATHY


Chronic swelling of the access hand and arm in a patient with proximal axillarry vein stenosis.

(Courtesy of JH Hong)


Three cases of radial steal syndrome following placement of vascular access

showing increasing degress of severity of ischemia. The two most severe cases

occurred in diabetics.(Courtesy of JH Hong)

Vascular Access Profile in Dr. Muwardi Hospital

October 2010Data Pasien HD

Tipe Access

Sumber Dana AV fist FemoralTunneled

CathGraft Jumlah

ASKES 19 21 6 - 46

JAMKESMAS (gratis)

19 39 2 - 60

SKTM(Keringanan)

17 18 2 - 37

PKMS (Pemkot, HD Gratis)

2 9 1 - 12

Pribadi 2 12 2 - 16

JUMLAH 59 99 13 - 171

How should I take care of my vascular access?You can take several steps to protect your access:

Make sure your nurse or technician checks your access

before each treatment.

Keep your access clean at all times.

Use your access site only for dialysis.

Be careful not to bump or cut your access.

Don’t let anyone put a blood pressure cuff on your

access arm.

Don’t wear jewelry or tight clothes over your access

site.

Don’t sleep with your access arm under your head or

body.

Don’t lift heavy objects or put pressure on your access

arm.

Check the pulse in your access every day.

the problem of vascular access

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