Senior Nurse Practitioner, University of Maryland Medical Center, Baltimore, MD.
Nephrol Nurs J. 2022 May-Jun;49(3):257-263.
Hemodialysis requires vascular access by way of an arteriovenous fistula (AVF), arteriovenous graft (AVG), or intravenous hemodialysis catheter. There is overwhelming evidence that an AVF should be the access of choice due to its lowest infection rate compared to an AVG or hemodialysis catheter; however, less than 17% of patients on hemodialysis have a functional AVF when hemodialysis treatment is initiated. Most patients with end stage kidney disease begin hemodialysis using a hemodialysis catheter, which has a higher infection rate. Nephrology nurses can advocate for best evidence-based practice, understanding that AVFs have lower infection and lower thrombosis rates, and provide more effective hemodialysis. This article provides a literature review for types and indications of hemodialysis access and how nurses can promote this best practice.
血液透析需要通过动静脉瘘（AVF）、动静脉移植物（AVG）或静脉内血液透析导管进行血管通路。有大量证据表明，由于感染率最低，AVF 应该是首选的通路，与 AVG 或血液透析导管相比; 然而，当开始血液透析治疗时，只有不到 17%的血液透析患者拥有功能正常的 AVF。大多数终末期肾病患者开始使用血液透析导管进行血液透析，其感染率更高。肾病护士可以倡导基于最佳证据的实践，了解到 AVF 的感染和血栓形成率较低，并提供更有效的血液透析。本文对血液透析通路的类型和适应证进行了文献回顾，并介绍了护士如何推广这种最佳实践。
