The majority of patients with kidney failure requiring replacement therapy will need the support of hemodialysis during their journey with kidney failure. A reliable functioning vascular access is required to provide hemodialysis. This Core Curriculum reviews the major forms of vascular access (arteriovenous fistula, arteriovenous graft, and central venous catheter) as well as the planning, preparation, creation, use, and maintenance of vascular access, requiring a P-L-A-N (Patient ESKD Life-Plan first then Access Needs) for each patient. The end-stage kidney disease Patient Life-Plan focuses on a strategy for kidney replacement modalities, while the Access Needs are the corresponding dialysis access(es) and management plans. The Access Needs include a vessel preservation plan, creation plan, contingency (complications) plan, and access succession plan. Stenosis and thrombosis are common problems with arteriovenous accesses, and dysfunction and infection are common problems with central venous catheters. Underrecognized and underreported but potentially life-threatening situations include arteriovenous access rupture and high-output cardiac failure. Effective management of these and other vascular access problems requires a coordinated multidisciplinary effort that is patient centered while preserving vascular access.

中文翻译：

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血液透析血管通路：2025 年核心课程。


大多数需要替代疗法的肾衰竭患者在肾衰竭过程中需要血液透析的支持。需要可靠、功能正常的血管通路来提供血液透析。本核心课程回顾了血管通路的主要形式（动静脉瘘、动静脉移植物和中心静脉导管）以及血管通路的规划、准备、创建、使用和维护，需要 P-L-A-N（首先是患者 ESKD 生命计划，然后是通路需求）为每位患者。终末期肾病患者生活计划侧重于肾脏替代方式的策略，而通路需求是相应的透析通路和管理计划。Access Needs 包括船舶保存计划、创建计划、应急（并发症）计划和Access Succession 计划。狭窄和血栓形成是动静脉通路的常见问题，功能障碍和感染是中心静脉导管的常见问题。未被充分识别和低报但可能危及生命的情况包括动静脉通路破裂和高输出性心力衰竭。有效管理这些问题和其他血管通路问题需要协调一致的多学科努力，以患者为中心，同时保留血管通路。