While the prevalence of AVF use in Australia and New Zealand is 75%, the number of prevalent patients
using a catheter has increased. In addition, the proportion of patients commencing haemodialysis with an AVF is decreasing. Currently only 40% of patients start dialysis with an AVF or arteriovenous graft (AVG) in Australia and 25% in New Zealand. In the USA the proportion of patients with a maturing or functional fistula at the start of haemodialysis is 31–34% with four selleck out of five patients starting dialysis with a catheter. AVF use in prevalent patients is 24% in the USA compared with 80% in Europe.[4, 5] Vascular access creation is a time consuming process as it involves patient education, surgical referral, surgical assessment, vascular access creation and subsequent maturation. Patients should be referred early to the nephrologist and vascular surgeon to allow sufficient time for education, planning, access creation and maturation. At present, the optimum timing for referral to vascular surgery for vascular access placement is based on expert opinion and choices made by patients and physicians. Thrombosis, stenosis, and infection are the three most prevalent complications of AVF and AVG increasing
reliance on central vascular catheters for dialysis access. Good cannulation technique, examination selleck products of the fistula or graft, and implementing proven infection control practices are essential to minimizing risk factors which compromise an efficient vascular access. Patient education on monitoring the site and prompt
reporting of any changes, and adherence to good hygiene, are crucial in preventing AVF/AVG failure. The objective of this guideline is to review and summarize the evidence on selection of type of access with reference to mortality, access type, access patency and cost. nearly Evidence on the use of diagnostic tests such as ultrasound and venography to determine access creation will also be examined. Recommendations for the preparation, placement and care of the vascular access will be addressed. No recommendations possible based on Level I or II evidence. * (Suggestions are based on Level III and IV evidence) Whenever possible it is suggested that a native AVF is created and used for haemodialysis, as it is superior to an AVG and to a central venous catheter. When a native AVF is not possible, an artificial AVG should be used in preference to a central venous catheter. AVGs have similar patency to AVF after accounting for AVF primary failure at the expense of greater interventions to maintain patency. Preoperative ultrasound should be performed where there are no obvious veins on clinical examination, or there are any concerns about size or patency.