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 :

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

 Infection rate increases with temporary catheter use.
 Nearly 75% of HD patients are hospitalized for vascular
access-related problem within 2 years.1
 Vascular access complications account for ~30% of hospital
admissions in chronic HD programs.2
 Estimates on the cost of hospitalization for vascular access
problems range from $2 billion3 per year to $3 billion4,
representing 10% to 15% of Medicare ESRD expenditures.
PROBLEM OF VASCULAR ACCESS
 PROBLEM OF VASCULAR ACCESS

• THROMBUS AV FIST • VENOUS STENOSIS • SEVERE EDEMA • INGUINAL

• KINGKIN TUNNELED • VENOUS THROMBOSIS • PATIENT NERVOUS HEMATOMA

CATH/POSITION • ANERISMA ARTERIEL • ARTERIEL VENOUS • THROMBUS

• YUXTA ANSTOMOSIS • STENOSIS ARTERIEL FRAGILE (DM)

STENOSIS • INFECTION AV GRAFT

• VENOUS CENTRALIS • THROMBUS/NEO INTIMAL
CATH STENOSIS HYPERPLASIA
• INFECTION TUNNELED/ AV
FIST/GRAFT
VASCULAR ACCESS COMPLICATION

THROMBOSIS AND INFECTION

VENOUS HYPERTENSION
RADIAL STEAL SYNDROME
ISHEMIC MONOMELIC NEUROPATHY
VASCULAR ACCESS COMPLICATION

Chronic swelling of the access hand and arm in a patient with

proximal axillarry vein stenosis.(Courtesy of JH Hong)
VASCULAR ACCESS COMPLICATION

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 2010
Data Pasien HD Tipe Access
Tunneled
Sumber Dana AV fist Femoral Graft Jumlah
Cath
ASKES 19 21 6 - 46
JAMKESMAS 19 39 2 - 60
(gratis)
SKTM 17 18 2 - 37
(Keringanan)
PKMS (Pemkot, 2 9 1 - 12
HD Gratis)
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.