Indications for placement of a cuffed, tunneled dialysis catheter include the following: exhaustion of other AV access site options; temporary transition from another form of dialysis (eg, renal transplant-acute rejection, peritoneal dialysis-related complications such as pleural leak); waiting for a live-donor kidney transplant with a scheduled surgical date in <90 days; notably limited life expectancy, <6 to 12 months; medical conditions that are exacerbated by the presence of an AV access such as nontreatable skin lesions at the site of cannulation high-flow with ejection factor <15%, patient scratching the skin over the AV access that is deemed to appreciably increase the risk of infection or access rupture risk; selection by patient after appropriate informed consent such as in the case of competent, >85-year-old elderly patient with needle phobia, high risk for AV access failure, and indeterminate life expectancy [5]. For example, Qa correlates closely with inflow stenoses in AVFs [73]. The KDOQI guidelines recommend AVF intervention when Qa is <450 to 500 mL/min [4]. Also, when the ratio of venous access pressure to the mean arterial pressure is >0.55, this has reflected a reliable predictor for the presence of an outflow stenosis in an AVG [78,79]. The core principle for performing routine vascular access monitoring and surveillance is to detect and treat the stenosis to preempt a reduction in dialysis clearance, to reduce the rate of thrombosis, and to improve AV access function [5]. In one prospective randomized control trial study, 58 AVFs were assessed for subclinical stenosis (>50% reduction in vessel diameter compared with the adjacent segment) and Qa >500 (<900) mL/min but with abnormal physical examination result, and elevated static venous pressure in groups that underwent prophylactic repair by surgery or PTA (pre-emptive intervention group) versus observation.
Dialysis Fistula Malfunction. Indications for placement of a cuffed, tunneled dialysis catheter include the following: exhaustion of other AV access site options; temporary transition from another form of dialysis (eg, renal transplant-acute rejection, peritoneal dialysis-related complications such as pleural leak); waiting for a live-donor kidney transplant with a scheduled surgical date in <90 days; notably limited life expectancy, <6 to 12 months; medical conditions that are exacerbated by the presence of an AV access such as nontreatable skin lesions at the site of cannulation high-flow with ejection factor <15%, patient scratching the skin over the AV access that is deemed to appreciably increase the risk of infection or access rupture risk; selection by patient after appropriate informed consent such as in the case of competent, >85-year-old elderly patient with needle phobia, high risk for AV access failure, and indeterminate life expectancy [5]. For example, Qa correlates closely with inflow stenoses in AVFs [73]. The KDOQI guidelines recommend AVF intervention when Qa is <450 to 500 mL/min [4]. Also, when the ratio of venous access pressure to the mean arterial pressure is >0.55, this has reflected a reliable predictor for the presence of an outflow stenosis in an AVG [78,79]. The core principle for performing routine vascular access monitoring and surveillance is to detect and treat the stenosis to preempt a reduction in dialysis clearance, to reduce the rate of thrombosis, and to improve AV access function [5]. In one prospective randomized control trial study, 58 AVFs were assessed for subclinical stenosis (>50% reduction in vessel diameter compared with the adjacent segment) and Qa >500 (<900) mL/min but with abnormal physical examination result, and elevated static venous pressure in groups that underwent prophylactic repair by surgery or PTA (pre-emptive intervention group) versus observation.