How to prevent dialysis access failure?
The complications that can cause dialysis access to fail include:
- Distortion due to the damage from repeated cannulations (pseudoaneurysm). While ultrasound can identify the stenosis, thrombosis, and anatomical distortions, it cannot prevent them
Infection is best prevented by conversion from a central venous line to an arteriovenous approach. Infection in arteriovenous fistulae or grafts are best prevented with the mandatory aseptic technique during the cannulation process, using sterile precautions and antiseptic cleansing, and gloves and masks. Patients and clinicians alike can examine the fistula or graft site for redness or undue tenderness.
Most stenosis occurs due to an injury at the site of stenosis. Thrombosis can also jeopardize the patency that any dialysis access requires. Two simple tests can provide reassurance that all is well:
- Palpation of a thrill: Which is the tactile feedback of turbulence in the fistula or graft
- Listening for a bruit: Which a clinician hears with a stethoscope
A thrill or a bruit is an indication that the site is communicating well between arterial and venous circulations.
Patients at high risk for thrombus formation can use anticoagulant therapy to prevent this.