At Fresenius Medical Care we want to take care of our patients in all aspects of the dialysis treatment and the medical professionals who care for them recognise that vascular access is the patient's lifeline.

There are several types of access - catheters, some temporary and some permanent.

Temporary access include the following kinds of catheters, which are flexible hollow tubes that are partially outside the body:

• Subclavian. This is a temporary catheter (sometimes can becomepermanent) placed into the subclavian vein just below thecollarbone.
• Internal jugular (IJ). This catheter is placed in the large vein inthe neck but is only used temporarily for a few weeks untilpermanent access is placed.
• Femoral. This is a temporary catheter placed in the large vein in the groin. It is only usually used while a patient is in hospital.

The most common permanent access for a patient undergoing chronic HD are Arterio-Venous Fistula (AVF) and grafts.

A fistula is formed under the skin by joining a vein to an artery. This increases the amount of blood that flows through the vein and causes the vein to get larger. The process of the fistula becoming strong and large enough for needle insertion is called maturing. In general, this takes 4 to 6 weeks.

A graft is created underneath the skin by connecting an artery and a vein with synthetic material. Following surgery, it may take about three to four weeks for swelling over the graft to go down so that the graft can be used for dialysis. Both access placements are done by a doctor and in an operating theatre.

Having good access is a major contributor to patient well-being. There is agreement among medical professionals that the preferred type of vascular access is a native arterio-venous fistula (AVF). Compared to catheters and arterial-venous grafts, native AVFs show significantly lower complication rates (such as infection and clotting), longer patency, fewer hospitalisations and lower patient morbidity.

To improve outcomes of haemodialysis access maintenance, it is important to develop a multidisciplinary approach involving nurses, nephrologists, vascular access surgeons and radiologists to monitor and maintain vascular access.