Vein Salvaging for Dialysis Patients
Obtaining vascular access is the most common invasive procedure for a hospitalized patient. Many patients have limitations for site choice. Reasons for these limitations include, but are not limited to: diagnosis, poor venous anatomy, existing surgical site, or injury from previous venipuncture.
For patients with chronic kidney disease (CKD), proper site choice for intravenous access is crucial for vein salvaging, as these patients will likely require a hemodialysis graft or fistula. The goal of the National Vascular Access Improvement Initiative (NVAII) is to promote the creation of a native fistula, which is the preferred form of access for dialysis. The ability to create a successful fistula is dependent on the patient’s peripheral vein health. Frequent and indiscriminate venipuncture and placement of central venous catheters, including peripherally inserted central catheters (PICC), can damage potential venous access for dialysis use.
For patients requiring short-term intravenous access for non-vesicant medications, the dorsal veins of the dominant hand should be the site of choice. If these veins are not accessible, or if medications to be infused are contraindicated for infusion in the smaller veins of the hand, the forearm will be the next site of choice. Use of the basilic and ulnar veins should be attempted and the radial and cephalic veins should be avoided if there is potential for future need of a fistula or graft. The veins in the antecubital fossa should be avoided at all costs.
Patients who are in need of dialysis have co-morbidities that inherently make venous access difficult. Choosing the appropriate site and type of infusion catheter for the patient’s needs should be a collaborative effort of the patient’s healthcare team.
Carol Brumsted RN, MSN, CRNI