Hemodialysis Access

Background

There are several means of vascular access through which hemodialysis (HD) can be performed, including catheters, arteriovenous fistulas (AVFs), and arteriovenous grafts (AVGs). These accesses provide the means for large-bore cannulas to be placed, usually in both an artery and a vein, thus facilitating a large volume of blood to exit and return to the patient after passing through a dialysis machine. HD access catheters are often abbreviated “permacath” or “Shiley”; however, this is incorrect nomenclature, as “Shiley” refers to a brand of tracheostomy tubes. Catheters should be referred to as non-tunneled or tunneled; however, as mentioned above, “Shiley” is often used in the hospital ward in reference to a non-tunneled HD catheter. A tunneled catheter is placed via a subcutaneous tract, which facilitates fibrous ingrowth and prevents catheter migration or accidental removal.