| [ Summary ] |
During the preparation, maintenance, and management of vascular access (VA), it is necessary to give due consideration to not only the general condition of hemodialysis patients but also theirvascular state and cardiac function. The presence of internal shunts, arteriovenous fistula or arteriovenous grafts (AVF/AVG), should also be taken into consideration in relation to the development of heart failure, because shunts can significantly affect hemodynamics. Heart failure can be caused by internal shunts due to their effects on cardiac output, cardiac reserve, and blood volume access. Accordingly, not only clinical findings, but also cardiac function and the access blood flow, should be monitored periodically. If cardiac function is sopoor that an AVF/AVG cannot be prepared or maintained, it may be necessary to employ a superficial repositioning of the artery or long term catheterization. |