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Vascular access refers to a rapid, direct method of introducing or removing devices or chemicals from the bloodstream. In hemodialysis, vascular access is used to remove the patient's blood so that it can be filtered through the dialyzer. Three primary methods are used to gain access to the blood: an intravenous catheter, an arteriovenous fistula (AV) or a synthetic graft. In the latter two, needles are used to puncture the graft or fistula each time dialysis is performed.
The type of vascular access created for patients on hemodialysis is influenced by factors such as the expected time course of a patient's kidney failure and the condition of his or her vasculature. Patients may have multiple accesses, usually because an AV fistula or graft is maturing and a catheter is still being used. The creation of all these three major types of vascular accesses requires surgery.[1]