THE PROBLEM OF VASCULAR

ACCESS

WURJANTO

UNS MEDICAL FACULTY/DR. MUWARDI HOSPITAL

 PENDAHULUAN
 VASCULAR ACCESS
 Persiapan utama HD
 Darah keluar dari tubuh, masuk mesin kembali ke
tubuh
 Aliran darah harus cukup dan konstan
 Sering terjadi problem
 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

HUMAN RESOURCES

EDUCATION OF PROBLEM OF VASCULAR ECONOMIC

PATIENT ACCESS OF PATIENT

MEDICAL
EQUIPTMENT
 PROBLEM OF VASCULAR ACCESS
VASC ACCESS (+) VASC ACCESS (-)

ACCUTE CHRONIC ACCUTE CHRONIC

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

• KINGKIN TUNNELED • VENOUS THROMBOSIS • PATIENT NERVOUS HEMATOMA

• ANERISMA ARTERIEL • ARTERIEL VENOUS • THROMBUS

CATH/POSITION
• 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)
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.
 TERIMA KASIH

GEREJA BLENDUG
KOTA LAMA