Which of the following is TRUE regarding vascular access in...

Which of the following is TRUE regarding vascular access in a chronic renal failure patient on hemodialysis? (A) Vascular graft thrombosis requires immediate surgical thrombectomy. (B) A nonfunctioning or infected Hickman catheter should be pulled in the ED. (C) Vascular graft infection often presents with signs of systemic sepsis and few classic signs of local infection. (D) "Steal syndrome," resulting in shunting of arterial blood away from the extremity distal to the vascular access, is common in patients with AV fistulas.

Which of the following is TRUE regarding vascular access in a chronic renal failure patient on hemodialysis?
(A) Vascular graft thrombosis requires immediate surgical thrombectomy.
(B) A nonfunctioning or infected Hickman catheter should be pulled in the ED.
(C) Vascular graft infection often presents with signs of systemic sepsis and few classic signs of local infection.
(D) "Steal syndrome," resulting in shunting of arterial blood away from the extremity distal to the vascular access, is common in patients with AV fistulas.

Key Concepts

Hemodialysis Vascular Access

Hemodialysis requires reliable vascular access that can accommodate high blood flow rates for efficient dialysis. Choices include arteriovenous fistulas, grafts, and central venous catheters, each with distinct techniques for creation, use, maintenance, and associated risks.

Vascular Graft Infection

Vascular graft infections in the context of hemodialysis often present atypically compared to other site-specific infections. Instead of clear local indicators, systemic signs like sepsis may be prominent, making clinical diagnosis challenging and necessitating prompt, targeted management.

Steal Syndrome

Steal syndrome refers to the diversion of arterial blood away from the distal circulation following the creation of an arteriovenous fistula. This results in relative ischemia in the limb distal to the point of access, potentially causing symptoms that may require intervention if severe.

Vascular Graft Thrombosis

Thrombosis within a vascular graft used for hemodialysis can lead to access failure. Management of such thrombosis requires careful evaluation, as treatment strategies can range from pharmacologic thrombolysis to interventional procedures, but not all situations mandate immediate surgical intervention.

Central Venous Catheter Management

Central venous catheters provide a temporary hemodialysis access route, but are prone to complications such as infection and malfunction. Decisions about removal or replacement must balance immediate risks with long?term access needs, and unsystematic removal in emergency settings can lead to adverse outcomes.

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