THE HEMODIALYSIS ACCESS - PREFERENCES AND CONCERNS OF PATIENTS, DIALYSIS NURSES AND TECHNICIANS, AND PHYSICIANS

One hundred twenty-eight hemodialysis patients and 64 medical personne l consisting of dialysis nurses and technicians, hemodialysis access s urgeons and nephrologists were surveyed about their preferences and co ncerns in regard to the hemodialysis vascular access. The access prefe rred by physicians was the A-V fistula in the lower arm. In contrast, the access preferred by dialysis nurses and technicians was the polyte trafluoroethylene (PTFE) graft in the lower arm. Patients desired a su perficial access in the forearm which was easy to cannulate, had minim al effect on their appearance, provided quick hemostasis after dialysi s and enabled arm comfort during dialysis, Physicians felt the most si gnificant concerns about the access were thrombosis and infection. Nur ses and technicians ranked difficult cannulation and insufficient acce ss blood flows that prohibited dialysis adequacy as their major proble ms. For patients the most common problem was pain during needle insert ion. This survey concluded that the A-V fistula remains the access of choice. However, appropriate maturation of the fistula must occur befo re needle insertion is attempted. An immature fistula is difficult to cannulate, has fragile veins resulting in blood leakage around the nee dle infiltrating the subcutaneous tissues and has inadequate blood flo ws for successful dialysis, Patients who are introduced to dialysis wi th inadequate access function or access failure from either an A-V fis tula or a PTFE graft have increased morbidity, inadequate dialysis and enhanced anxiety about dialysis treatments. To increase the success a nd acceptance of A-V fistulas in hemodialysis patients it is incumbent upon the nephrologist to protect the future access arm from damage to the vasculature and to allow for fistula maturation before cannulatio n, Surgical protocols must improve the appropriate selection of a fist ula or PTFE graft for various age groups and disease categories. Bette r patient preparation and selection of the proper access type for each patient will enhance early access function and subsequent access surv ival.