Vascular Access Procedures: All You Should Know

Vascular access procedures refer to the creation of a pathway through which blood can be removed from and returned to the body. This procedure is performed in individuals who require hemodialysis or chemotherapy. Vascular access can be created using either a temporary or permanent access site, which can be achieved by various methods.

Types of Vascular Access:

There are three main types of vascular access: arteriovenous (AV) fistula, arteriovenous graft, and central venous catheter. The choice of vascular access depends on various factors such as the patient’s age, medical history, and condition.

Arteriovenous Fistula:

An AV fistula is created by surgically connecting an artery to a vein. This procedure allows for high blood flow rates and is considered the best option for long-term hemodialysis. The AV fistula requires several weeks to mature before it can be used for hemodialysis. This is because the vein must enlarge and thicken to accommodate the high blood flow rate required for hemodialysis.

Arteriovenous Graft:

An arteriovenous graft is a synthetic tube that connects an artery to a vein. The graft is usually made from a synthetic material such as polytetrafluoroethylene (PTFE). The graft is used when the patient’s veins are not suitable for an AV fistula. The graft can be used immediately after it is placed, but it is not as durable as an AV fistula and is prone to clotting.

Central Venous Catheter:

A central venous catheter is a tube that is inserted into a large vein in the neck, chest, or groin. The catheter can be used immediately after it is placed, but it is associated with a higher risk of infection and thrombosis. The catheter is usually used as a temporary access site and is not recommended for long-term use.

Preparing for Vascular Access Procedure:

Before the procedure, the patient will undergo several tests to assess their overall health and the condition of their blood vessels. These tests may include blood tests, imaging studies such as ultrasound or angiography, and a physical examination.

During the Procedure:

The procedure is usually performed under local anesthesia, and the patient is awake during the procedure. The type of anesthesia used depends on the type of procedure being performed. The procedure usually takes between one to two hours, depending on the type of vascular access being created.

After the Procedure:

After the procedure, the patient will be monitored for several hours to ensure that there are no complications. The patient will be advised to avoid heavy lifting and strenuous activity for several weeks after the procedure to allow the vascular access to heal.

Complications of Vascular Access:

Complications associated with vascular access procedures include infection, bleeding, thrombosis, and stenosis. Infection is the most common complication and is usually treated with antibiotics. Bleeding can be managed with pressure and, in severe cases, may require surgery. Thrombosis is a blood clot that can form in the blood vessels and is usually treated with blood thinners. Stenosis is a narrowing of the blood vessels and can be treated with angioplasty or surgery.

Maintenance of Vascular Access:

The maintenance of vascular access is important to prevent complications such as infection and thrombosis. The patient should avoid any trauma to the access site and should keep the site clean and dry. The patient should also avoid using the access site for any other medical procedures such as blood draws or injections.

The patient should also undergo regular monitoring to ensure that the access site is functioning properly. This may include regular blood flow measurements, ultrasound scans, and physical examinations. The patient should also be educated on the signs and symptoms of complications and instructed to seek medical attention immediately if they occur.