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 infectionrelated.

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 billion 3

per year to $3 billion4, representing 10% to 15%
of Medicare ESRD expenditures.

PROBLEM OF VASCULAR
ACCESS

PROBLEM OF VASCULAR ACCESS

THROMBUS AV
FIST
KINGKIN

VENOUS STENOSIS

SEVERE EDEMA

VENOUS

PATIENT

THROMBOSIS

NERVOUS
ARTERIEL

TUNNELED

ANERISMA ARTERIEL

CATH/POSITION

STENOSIS ARTERIEL

VENOUS FRAGILE

INFECTION AV GRAFT

(DM)

YUXTA
ANSTOMOSIS
STENOSIS
VENOUS
CENTRALIS CATH
STENOSIS

THROMBUS/NEO
INTIMAL
HYPERPLASIA
INFECTION
TUNNELED/ AV
FIST/GRAFT

INGUINAL
HEMATOMA
THROMBUS

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
Tipe Access
HD

AV fist

Femoral

Tunneled
Cath

Graft

Jumlah

ASKES

19

21

46

JAMKESMAS
(gratis)

19

39

60

SKTM
(Keringanan)

17

18

37

PKMS
(Pemkot, HD
Gratis)

12

Pribadi

12

16

59

99

13

171

Sumber Dana

JUMLAH

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.
Dont let anyone put a blood pressure cuff on your
access arm.
Dont wear jewelry or tight clothes over your access
site.
Dont sleep with your access arm under your head or
body.