Journal of nephrology
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Journal of nephrology · May 2006
ReviewDo central venous catheters have advantages over arteriovenous fistulas or grafts?
Central venous accesses have become an integral component of vascular access procedures for hemodialysis. Although the DOQI guidelines recommend that less than 10% of chronic hemodialysis patients should be maintained on catheters, in some countries higher prevalences are reported, as in the United States and the United Kingdom (18% and 24%, respectively, according to the DOPPS). The native arteriovenous fistulas are still the best suited accesses for hemodialysis. ⋯ In a matched comparison between Tesio twin catheters and Dialock ports (37 vs. 35, respectively), followed for a 2 year period, no significant differences emerged as regards bacteremia incidence, 0.58/1,000 catheter-days in the Tesio catheter group vs. 0.9/1000 catheter-days in the subcutaneous port group, p=0.12; thrombolytic agents needed, 4.5% vs 4.3% of dialysis sessions; or access failure with removal of the device, 8.1% vs 14.2%, p=0.4. The longer duration of antibiotic therapy in the Tesio group (24.6 vs 14.3 days, p=0.006) was due to the higher incidence of cutaneous infectious episodes (3.8 vs 0.16/1,000 catheter-days). In conclusion, although central venous catheter is the vascular access of last choice, in particular cases it can be a useful alternative, provided that strict protocols for nursing care and proper catheter management are implemented in every center.
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A well-functioning vascular access for hemodialysis plays a key role in the quality of life and clinical outcome of dialysis patients. A vascular access for dialysis is considered to be adequate when it provides a blood flow of at least 250 ml/min in the standard dialysis and up to 350-400 ml/min in the high-efficiency dialysis. So far, Cimino-Brescia arterio-venous fistula still remains the gold standard among the available vascular accesses. ⋯ The most important complications of vascular access are stenoses, thromboses, infections. Infections, more frequent in synthetic vascular access than in native fistulas, are responsible for the increase in patients' morbidity and, consequently, in public health costs. An integrated multi-professional approach of vascular access, involving nephrologists, vascular surgeons, interventional radiologists, and trained dialysis nurses should be implemented in order to early detect vascular access complications and failure.