Challenges of vascular access in a new dialysis centre – Uyo experience

BACKGROUND Introduction of dialysis has prolonged the lives of end-stage renal disease patients. To maintain these patients on long term dialysis, permanent vascular access procedures capable of allowing flow of >200ml of blood/minute, are required. Without permanent vascular access, patients are subjected to repeated attempts for cannulation to provide temporary vascular access during every session of haemodialysis, risked with numerous vascular access related complications. The objective of the study was to analyse the problems of vascular access in our new dialysis centre and plan intervention. METHODS Case notes and dialysis records of consecutive patients who underwent haemodialysis in our dialysis centre during its first one year were used to collect data into proforma, and these were analysed. RESULTS There were 60 patients who underwent a total of 254 sessions of haemodialysis during the period. Their ages ranged from 12-72 years. There were 38 males and 22 females. There were 57 patients with end-stage renal disease and three with acute renal failure. Only 5% of the patients underwent dialysis through a permanent vascular access representing 8% of dialysis. The remaining 95% of patients undergoing 92% of haemodialysis utilised temporary vascular accesses. Complications arising from vascular access were noted in 24.0% of dialysis and these included failed or difficult cannulation, poor flow, haematoma, haemorrhage, kinked catheter, thrombosis and infection. CONCLUSION The ratio of temporary to permanent vascular access of 92:8 noted in our dialysis centre was unacceptably high compared to the internationally recommended 15:85.