Revisiting quality standards in hemodialysis vascular access: where is the bar?

Vascular access performance is closely linked to adequacy of hemodialysis. Clinical practice guidelines are available to assist practitioners in determining best practice in the area of hemodialysis vascular access. For various reasons, in Canada, there is a lower than recommended rate of arterio-venous (AV) fistula use and an increasing trend toward use of central venous catheters (CVC) for hemodialysis access. The result is an environment wherein hemodialysis nursing staff has an important role to play in addressing barriers to fistula prevalence and maximizing opportunities for fistula creation. Moreover, meeting standards for blood flow with all vascular accesses including CVCs in day-to-day practice is paramount to hemodialysis adequacy and positive outcomes. Through a case study approach, this manuscript revisits the existing stanadrds for vascular access including CVC function, discusses the importance of meeting those standards to achieving hemodialyis adequacy, and discusses the use of thrombolytic therapy as a potential strategy or the management of catheter malfunction.